503808989-10-9-2023-04-CC-JPAO-CWFQGW-20231009121012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503808989
Report Date: 10/09/2023
Date Signed: 10/09/2023 12:10:20 PM

Document Has Been Signed on 10/09/2023 12:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	HAZEL'S CHRISTIAN PRESCHOOL&CHILD CARE CENTER II		FACILITY NUMBER:	503808989
ADMINISTRATOR:	DOMSON, HAZEL		FACILITY TYPE:	840
ADDRESS:	1528 OAKDALE RD		TELEPHONE:	(209) 521-4422
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	15	CENSUS: 0	DATE:	10/09/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Hazel Domson - Licensee		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/9/23, Licensing Program Analyst (LPA) Joseph Pacheco conducted an announced Case Management inspection and met with Licensee, Hazel Domson. Facility was closed and no children were present during the inspection. LPA explained the reason for the inspection and a tour of the center was conducted both inside and outside. This program currently operates year round from 6:00 AM to 7:00 PM and currently utilizes classrooms 4 and 5. The licensee is requesting a decrease of capacity from 15 school age children to 12 school age children. Classroom 4 is no longer going to be used by school age children and will now be used by preschool children. Parents provide food for lunches. Facility provides a morning and afternoon snack. Facility has food available in the event a parent forgets to provide their child with food. Facility does not have a kitchen on site to prepare meals. Ill children and staff will utilize the staff bathroom. Ill children will be isolated in the director’s office until picked up by their parent or legal guardian. Cleaning supplies are kept in inaccessible areas in all classrooms. All classrooms appeared to be clean and free of toxins. LPA observed that the furniture and equipment in the classrooms appeared to be safe and in good condition. LPA observed that the center has a working carbon monoxide detector installed. LPA observed that there are plenty of tables and chairs and sleeping cots. Classroom items and toys appeared to be age appropriate. Room measurements in all classrooms were taken and reviewed with Director. The total inside preschool area measured to an approximate 221 square feet which will only accommodate a capacity of 6 school age children. Licensee provided LPA with an amended application for 6 school age children during today’s inspection. There is a total of 5 toilets, 3 urinals and 3 sinks/hand washing fixtures which will accommodate the requested capacity. Facility utilizes drinking water from an outside water service. Facility utilizes water pitchers in each classroom to make water readily available for children. Facility brings the water pitchers and a paper cup dispenser outside to provide to children during outdoor activities. The outside square footage measured 6,536 square feet which will accommodate the newly requested capacity of 6 school age children. Outside toys and equipment appeared to be age appropriate. Preschool age children and school age children utilize the same outdoor space at separate times. Adequate shade is available in the outdoor activity area. CONTINUED ON LIC809-C

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HAZEL'S CHRISTIAN PRESCHOOL&CHILD CARE CENTER II	FACILITY NUMBER: 503808989
	VISIT DATE: 10/09/2023

NARRATIVE

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Licensee is utilizing mature trees for shade. Facility is utilizing wood chips to provide adequate cushioning for high climbing equipment. LPA reminded Licensee to make sure they have visual supervision of children at all times.

A fire clearance for 12 school age children was received and granted by the City of Modesto Fire Department on 10/2/23. An amended fire clearance for 6 school age children will be needed.

Pending a final file review, a recommendation will be made to license the above facility for a capacity of 6 school age children.

The following documents are to be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)
* Activity Schedule

This facility plans to provide Incidental Medical Services – IMS. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
CONTINUED ON LIC809-C

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HAZEL'S CHRISTIAN PRESCHOOL&CHILD CARE CENTER II	FACILITY NUMBER: 503808989
	VISIT DATE: 10/09/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with Licensee, Hazel Domson.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC809 (FAS) - (06/04)

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