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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700527
Report Date: 06/26/2024
Date Signed: 06/26/2024 10:22:42 AM

Document Has Been Signed on 06/26/2024 10:22 AM - 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/
DIRECTOR:		BRUMFIELD, AZIZAFACILITY TYPE:
850
ADDRESS:14830 WASHINGTON AVENUETELEPHONE:
(510) 567-3733
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 16DATE:
06/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Essie DayTIME VISIT/
INSPECTION COMPLETED:
10:14 AM
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On 6/26/2024 at 8:30am Licensing Program Analyst (LPA) Morgan Pringle conducted an unannounced Case Management Plan of Correction inspection. LPA Michael Mathew and Licensing Program Manager (LPM) Wynn Norona were present as well conducting a Plan of Correction inspection for a prior complaint. LPAs and LPM arrived at the facility and were met by facility staff at the front door. LPA Pringle informed the staff member of the nature of the visits and they entered the facility. Present during the inspection were seven (7) toddlers, nine (9) preschoolers and three (3) additional staff members and two (2) aides. The owner of the facility arrived around 8:45am.

On 6/12/2024 LPA Pringle and LPA Uribe conducted a case management visit for a flood that occurred at the facility on 2/22/2024 around 12:18pm. It was found that sewage water had flooded the facility when children were present in care. A Type A deficiency was cited for the flood of sewage water and a Type B deficiency was cited for the facilities failure to report the incident to the Community Care Licensing Division (CCLD) Oakland Regional Office (RO).

On 6/12/2024 the facility was also cited a Type A deficiency for being out of ratio in the toddler classroom. The facility had been cited on two (2) prior visits before the Case Management inspection on 6/12 which prompted the Type A deficiency.

Facility owner was given a plan of correction date of 6/13/2024 to:
· Produce a receipt of plumbing company that was used for the flooding that occurred on 2/22/2024 that
shows proper sewage water removal and sanitization of the facility.
· Submit an Unusual Incident/Injury Report (LIC624) for the flooding to the RO.
· Send LPA Pringle a plan stating how the facility will meet the ratio requirements moving forward for
adequate staffing.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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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: 06/26/2024
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Owner stated she walked in the documents needed for the appeal to the RO. Due to the three deficiencies currently being under appeal there are no deficiencies being cited today.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility owner, Essie Day.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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