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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808990
Report Date: 02/23/2022
Date Signed: 02/23/2022 04:09:22 PM

Document Has Been Signed on 02/23/2022 04:09 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HAZEL'S CHRISTIAN PRESCHOOL&CHILD CARE CENTER IIFACILITY NUMBER:
503808990
ADMINISTRATOR:DOMSON, HAZELFACILITY TYPE:
830
ADDRESS:1528 OAKDALE RDTELEPHONE:
(209) 521-4422
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 10DATE:
02/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director, Hazel DomsonTIME COMPLETED:
04:15 PM
NARRATIVE
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On 2/23/22, Licensing Program Analyst (LPA), Jose Penate conducted a Case Management visit. LPA met with Director, Hazel Domson and a tour of the facility. LPA observed all children and staff wear thick coat and sweaters during nap time, LPA verified the thermostat and confirmed that the temperature at the facility was 52 degrees in the East building and in the West building it was 61 degrees. LPA immediately advised director of observation made and had the heater turned on for the comfort of children and staff. After speaking with staff it was disclosed that the temperature in the facility has been cold and that most children did wear their jackets because of the temperature in each classroom.

Per California Code of Regulations, Title 22, Division 12, the following deficiencies are cited, see LIC-809D.

Exit interview was conducted with Director, Hazel Domson.

A Notice of Site Visit Form was posted and must remain posted for 30 days.

The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of this form.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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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Document Has Been Signed on 02/23/2022 04:09 PM - It Cannot Be Edited


Created By: Jose Penate On 02/23/2022 at 03:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HAZEL'S CHRISTIAN PRESCHOOL&CHILD CARE CENTER II
FACILITY NUMBER: 503808990

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2022
Section Cited
CCR
101239(a)(1)

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(a) A comfortable temperature for children shall be maintained at all times. (1)The licensee shall maintain the temperature in rooms that children occupy between a minimum of 68 degrees F (20 degrees C) and a
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Director adjusted the thermostat to 85 degrees to allow heat into each classroom.
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maximum of 85 degrees F (30 degrees C). Based on LPA observation, the temperature at the center was at 61 degrees in east building and 52 degrees in west building. This poses a potential risk and safety for the children in care.
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LPA advised Director to adjust the temperature accordingly based on the outside temperture and for comfort of children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022


LIC809 (FAS) - (06/04)
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