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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700527
Report Date: 11/05/2021
Date Signed: 11/05/2021 01:44:35 PM

Document Has Been Signed on 11/05/2021 01:44 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CREATIVE WORLDFACILITY NUMBER:
015700527
ADMINISTRATOR:JACKSON, AMARISFACILITY TYPE:
850
ADDRESS:14830 WASHINGTON AVENUETELEPHONE:
(510) 567-3733
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 49TOTAL ENROLLED CHILDREN: 49CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Amaris Jackson & Essie DayTIME COMPLETED:
02:05 PM
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A Prelicensing Visit was conducted today by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Applicant, Essie Day and Director, Amaris Jackson. The applicant has submitted an application for a PRESCHOOL with a TODDLER OPTION license. A health and safety inspection was conducted inside and outside. The preschool program will operate in 3 classrooms (Classroom #1 & 2 for Preschoolers) and (Classroom #3 for Toddler Option). Facility will also utilize a GROSS MOTOR SKILLS ONLY ROOM (Room #4).Operating hours Monday through Friday from 6:00AM - 6:00PM. The measurements are as follows:

INDOORS: 1116.56 square feet = 32 children
OUTDOORS: 1204.26 square feet = 16 children

Measurements were taken of each room and of the out door play yard. There is one separate staff bathroom which will be utilized for an isolation restroom if a child becomes ill. A waiver and a yard schedule will be submitted for yard space never to exceed more than 16 children between the yard and gross motor skills room at one time. There is a fully stocked first aid kit with all required equipment available and a locked cabinet for stored medications. Kitchen will be utilized for food prep. Facility will have food catered or children can bring lunch from home. AM/PM snacks also provided by facility. No exit doors were blocked. There is ample toys and furnishings throughout the center for children's use. There are cots available for children.

There are 4 toilets (sized appropriately) and 3 sinks available for children's use. Heating and lighting was adequate. The play yard is on the side of the building and contains bikes, and a small basketball hoop. The play yard is cushioned with poured rubber to cushion a fall. Facility will also utilize Room #4 for GROSS MOTOR SKILLS ONLY. Room #4 is not to be used for any classroom instruction.

Report continued on 809C
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527
VISIT DATE: 11/05/2021
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The center Director will be Amaris Jackson and a directors packet with all required documentation was submitted to CCL to complete the application. There is an approved fire clearance signed on 10/12/2021 for 49 preschool aged children which includes the option to have 15 toddlers aged 18 months to 36 months.

There are no bodies of water nor hazards found on the premises. Playground equipment is in good condition. Drinking water is available inside and outside. All toilets and hand washing facilities are in safe and sanitary operating conditions. All licensing required documents are posted. This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

A license for 32 preschoolers operating out of 3 classrooms (Classrooms #1 & 2 for Preschoolers) with the option to include up to 15 toddlers (Classroom #3 for Toddlers) and a gross motor skills only room (Room #4) recommended effective today, 11/5/2021.

An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC809 (FAS) - (06/04)
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