<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700527
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:34:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2024 and conducted by Evaluator Michael Mathew
COMPLAINT CONTROL NUMBER: 52-CC-20240610123607
FACILITY NAME:CREATIVE WORLDFACILITY NUMBER:
015700527
ADMINISTRATOR:BRUMFIELD, AZIZAFACILITY TYPE:
850
ADDRESS:14830 WASHINGTON AVENUETELEPHONE:
(510) 567-3733
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:32CENSUS: 26DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Asia williamsTIME COMPLETED:
11:53 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
 Staff does not keep facility free from odor.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/12/24 at 8:49 AM Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced inspection for a complaint investigation. LPAs Morgan Pringle and Christina Uribe was present for a case management inspection. LPAs met with facility staff and informed her the purpose of the inspection. Facility staff provided LPA a tour of the facility inside and out. There were 26 children and 3 staff members and 2 miner aids in care at the time of the inspection. At 10 AM LPA was met with owner Essie Day.

Allegation:Staff does not keep facility free from odor. .Based on LPAs interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation of Staff does not keep facility free from odor. is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 Article 06.section 101223(a)(2) Personal rights, are being cited on the attached LIC 9099D.

cont 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 52-CC-20240610123607
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527
VISIT DATE: 06/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Mathew informed owner Essie Day that this report dated 6/12/2024 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Mathew informed the owner Essie Day to provide a copy of this licensing report dated 6/12/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. .


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.

Exit interview conducted, appeal rights were given, and report was reviewed with the owner Essie Day

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 1 of 1
Control Number 52-CC-20240610123607
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
CCR
101223(a)(2)
1
2
3
4
5
6
7
(a) The licensee shall ensure that each child is accorded the following personal rights:
:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The facility has until 6:00pm 06/13/24 to obtain an appointment with a business which specializes in bacterial analysis of indoor, commercial buildings. This appointment must be made for the facility to obtain a bacterial analysis within 15 days of today. Proof of having made this appointment will be emailed
8
9
10
11
12
13
14
Based on observations made by LPAs, a strong, concerning, unknnown odor was detected being present inside of the facility. Due to the unknown and strong nature of the odor, it is determined that this is an immediate risk to the health, safety, or personal rights to children in care.
8
9
10
11
12
13
14
to LPA Mathew at michael.mathew@dss.ca.gov no later than the due date of 06/13/24 by 6:00pm. The purpose of this appointment is to determine what is causing the strong, unknown odor within the facility.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 1