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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700527
Report Date: 03/06/2024
Date Signed: 03/06/2024 12:03:39 PM

Document Has Been Signed on 03/06/2024 12:03 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:CHIO, AMANDAFACILITY TYPE:
850
ADDRESS:14830 WASHINGTON AVENUETELEPHONE:
(510) 567-3733
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 32TOTAL ENROLLED CHILDREN: 36CENSUS: 23DATE:
03/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Aziza BrumfieldTIME COMPLETED:
12:03 PM
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On 3/6/2024 Licensing Program Analyst (LPA) Morgan Pringle met with facility Director Aziza Brumfield for an Unannounced Case Management Visit to clear deficiencies that were cited during a previous visit conducted on 1/24/2024. LPA entered the facility behind a maintenance worker and walked into Room 1. LPA introduced herself to the Director and informed the Director of the nature of the visit. LPA toured the facility. Present during LPA's visit were three (3) additional staff members, thirteen (13) preschool age children and eight (8) toddlers.

On 1/24/2024 LPAs Morgan Pringle and Christina Uribe conducted a site visit and found four (4) staff members present did not have LIC503 Health Screening Report, on file. Facility was given until 2/23/2024 to obtain all missing documents.

During today's visit it was found that three (3) of the four (4) staff members are no longer employed at the facility. The one (1) remaining document has been completed and placed into the staff members file.

No deficiencies were cited during LPAs visit.

A notice of site visit was provided and exit interview conducted with Director Aziza Brumfield.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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