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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 10:40:59 AM

Document Has Been Signed on 06/26/2024 10:40 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
OAKLAND SOUTH EAST, 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:Asia WilliamsTIME VISIT/
INSPECTION COMPLETED:
10:51 AM
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On 6/26/24, Licensing Program Analysts (LPA's) Michael Mathew, Morgan Pringle and Licensing program Manager(LPM) Wynn Norona arrived at the facility for an Unannounced Plan of Correction (POC) Inspection to follow up on deficiencies cited on a Complaint conducted on 6/12/24. LPA met with facility staff . During the inspection there were 16 children and 3 Adults and 2 additional aids . POC was cleared during visit.

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 and report was reviewed with the licensee.

No deficiency was cited in today’s visit.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
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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