503810076-10-9-2023-04-CC-JPAO-CWFSE6-20231009134812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503810076
Report Date: 10/09/2023
Date Signed: 10/09/2023 01:48:16 PM

Document Has Been Signed on 10/09/2023 01:48 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		FACILITY NUMBER:	503810076
ADMINISTRATOR:	DOMSON, ODOOM/HAZEL		FACILITY TYPE:	830
ADDRESS:	920 ILA WAY		TELEPHONE:	(209) 735-9359
CITY:	MODESTO	STATE: CA	ZIP CODE:	95354
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/09/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Hazel Domson - Licensee		TIME COMPLETED:	02:00 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. The facility was closed and no children were present on this date. LPA explained the reason for the inspection and a tour of the center was conducted both inside and outside. The licensee is requesting an increase of capacity from 8 infant children to 28 infant children by adding one additional classroom. This program currently operates year round from 6:00 AM to 7:00 PM in classroom 2. The increase of capacity will operate in classroom 1. Licensee stated that the parents provide all food, snacks, diapers and wipes. Children in both classrooms include crib infants and nap at individualized schedules. Ill children will be isolated in the director’s office and utilize the staff bathroom adjacent to the director’s office. Cleaning supplies are kept in locked storage areas which are inaccessible to children. Both infant classrooms were observed to be clean and free of toxins. LPA observed that the furniture and equipment in each classroom appeared to be safe and in good condition. LPA observed that the center has a working carbon monoxide detector installed. Facility will need to obtain additional cribs and sleeping mats. LPA observed plenty of age appropriate items & toys. Room measurements in both classrooms were taken and reviewed with Licensee. The total inside infant area of both classrooms measured to an approximate 790 square feet which will only accommodate 22 infants. Licensee provided an updated application for 22 infants during today’s inspection. There is adequate storage space available for children's belongings. There are a total of 3 potty training toilets, 3 toilets and 2 sinks/hand washing fixtures which will accommodate the newly requested capacity. Facility uses water provided by an outside vendor to fill pitchers located in each classroom. Staff bring the water pitchers outside during outdoor activities. Children bring their own water bottles from home, but the facility keeps cups on hand in the event a child does not have a water bottle. The outside square footage measured to an approximate 24,725 square feet which will accommodate 22 infant children. Shade structures and mature trees provide a shaded rest area. No high climbing play equipment was observed. LPA reminded Licensee to make sure they maintain visual supervision of children at all times. CONTINUED ON LIC809-C

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
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	FACILITY NUMBER: 503810076
	VISIT DATE: 10/09/2023

NARRATIVE

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A fire clearance for 28 infant children was received and granted by the City of Modesto Fire Department on 10/2/23. An amended fire clearance for 22 infant children will be needed.

The following item must be completed prior to issuing a license for 22 infant children.

Inside Daycare:
1) Obtain additional cribs and/or sleeping cots so facility will have enough to accommodate the requested capacity of 22 infant children.

Pending a final file review and completion of the above item, a recommendation will be made to license the above facility for a capacity of 22 infant children.

The following documents should 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
* Lead Poisoning brochure

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/.
CONTINUED ON LIC809-C

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
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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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	FACILITY NUMBER: 503810076
	VISIT DATE: 10/09/2023

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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

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 to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door 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

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
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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