Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317630
Report Date: 03/09/2016
Date Signed: 03/09/2016 10:11:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:HAZELTON ELEMENTARY SCHOOLFACILITY NUMBER:
390317630
ADMINISTRATOR:RAY SCHRAMFACILITY TYPE:
850
ADDRESS:535 W. JEFFERSONTELEPHONE:
(209) 944-4212
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:46CENSUS: 39DATE:
03/09/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Linda Delacy & Erica RichardTIME COMPLETED:
10:20 AM
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LPA Kelly met with Lead Teachers Linda Delacy and Erica Richard and 4 Teacher Assistants for the purpose of an annual random visit. At the time of visit there were 20 children present. In Ms. Delacy's class, there were 20 children present, and in Ms. Richard's class there were 19 children present. These are both morning classes schedule: 8:00 to 11:30 am.

LPA Kelly toured the center including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play area. LPA reviewed care and supervision of children, staffing ratios, health related services, first aid supplies, furniture, equipment, drinking water and food service provisions.

Food is provided through the school district. Staff stated there is one child on medication.

LPA observed that all of the required forms were posted including a license, parents' rights' poster, emergency care and disaster plan and seat belt law, reviewed the sign/in-sign/out sheet, children's and personnel records. At least one staff member present today has current Pediatric CPR and First Aid.

No Title 22 Deficiencies cited during todays visit. Notice of Site Visit Posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2016
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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