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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700527
Report Date: 07/26/2022
Date Signed: 07/26/2022 02:06:46 PM

Document Has Been Signed on 07/26/2022 02:06 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: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 10DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sugar Sharay Charlotte PorterTIME COMPLETED:
02:30 PM
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On July 26, 2022, at approximately 11:30 AM, Licensing Program Analyst (LPA) Elimika Woods met with Director, Sugar Sharay Charlotte Porter for an Unannounced Case Management inspection to check the director's qualification. Present for the inspection were 10 preschool age children and two additional staff members.

LPA conducted interviews and gathered paperwork with the teacher and director.

As a result of today's inspection there was no deficiencies cited today.

Appeal Rights were discussed. A notice of site visit was posted by the director and exit interview was given.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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