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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700527
Report Date: 01/24/2024
Date Signed: 01/24/2024 02:54:37 PM

Document Has Been Signed on 01/24/2024 02:54 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CREATIVE WORLDFACILITY NUMBER:
015700527
ADMINISTRATOR:CHIO, AMANDAFACILITY TYPE:
850
ADDRESS:14830 WASHINGTON AVENUETELEPHONE:
(510) 567-3733
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 24DATE:
01/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stephanie JosephTIME COMPLETED:
03:15 PM
NARRATIVE
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On 01/24/2024 at 9:30am, Licensing Program Analysts (LPAs) Christina Uribe & Morgan Pringle conducted an unannounced Case Management visit and met with Director, Stephanie Joseph. Also present at the time of the inspection is 5 staff members and 24 children. The purpose of today's visit was to investigate a complaint and during the course of the investigation, LPAs found deficiencies unrelated to the complaint resulting in this case management report.

At around 11:30am, LPA Pringle went into the preschool classroom and observed one teacher's aide to be alone with 13 children. A few minutes later, LPA Pringle went back into the classroom to verify that ratio was out of compliance and then went to another room and notified the Director that the classroom was out of ratio. The Director then stepped into the classroom to assist and meet compliance. Due to the classroom being out of ratio, a Type B Violation is being cited today. Please see deficiency page LIC 809D for additional information and plan of correction. Plan of correction is due on 02/07/24.

During record review, LPAs Uribe & Pringle found that some staff members did not have a signed and/or completed Health Screening Report (LIC 503) form in their personnel file. On 10/04/23 during an annual inspection, the facility was issued a Technical Violation for incomplete LIC 503 forms. Due to the advisory note being previously issued by way of a technical violation and LPAs observing these forms still missing today, a Type B Violation is being cited. Please see deficiency page LIC 809D for additional information and plan of correction. Plan of correction is due on 02/23/24.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeals rights were given and reviewed. Exit interview was conducted and report was reviewed with the director, Stephanie Joseph.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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 01/24/2024 02:54 PM - It Cannot Be Edited


Created By: Christina Uribe On 01/24/2024 at 12:20 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2024
Section Cited
CCR
101216.3(a)

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101216.3: Teacher-Child Ratio (a) There shall be a ratio of one teacher visiually observing and supervising no more than 12 children in attendance.

This requirement was not met as evidenced by:
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Director and staff will watch the "Teacher-Child Ratio" training video on the CCLD website. Director will conduct a staff meeting and discuss ratio requirements and come up with a plan of action to ensure that ratio is maintained at all times. The director will create a written statement of this plan
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During the visit, LPAs observed one teacher's assistant left alone in a classroom with 13 children which poses a potential risk to the health, safety, or personal rights to children in care.
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of action and explain the ratio requirements for a preschool center as stated in the training video. All staff, including director, will sign and date this written statement. Director will email this signed written statement to LPA Pringle at morgan.pringle@dss.ca.gov no later than the due date of 02/07/24.
Type B
02/23/2024
Section Cited
CCR101216(g)(2)

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101216: Personnel Requirements (g)(2) All personnel shall have a health-screening report signed by the person performing the screening.

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Director will ensure that all staff members have a signed and completed Health Screening Report (LIC 603) form in their personnel files. Director will email copies of each staff member's LIC 503 forms to LPA Pringle at morgan.pringle@dss.ca.gov no later than the due date of 02/23/24.
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During record review, LPAs Uribe & Pringle found that some staff members did not have a complete Health Screening Report (LIC 503) form in their personnel file which poses a potential risk to the health, safety, or personal rights to 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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


LIC809 (FAS) - (06/04)
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