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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808946
Report Date: 07/28/2021
Date Signed: 07/28/2021 03:04:45 PM

Document Has Been Signed on 07/28/2021 03:04 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CRE8TIVE KIDS CAMPUSFACILITY NUMBER:
153808946
ADMINISTRATOR:RISI, CHARLOTTEFACILITY TYPE:
850
ADDRESS:307 MAIN STTELEPHONE:
(661) 424-7822
CITY:TAFTSTATE: CAZIP CODE:
93268
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 19DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Teresa ValenzuelaTIME COMPLETED:
03:15 PM
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On 7/28/2021, Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced annual inspection at Cre8tive Kids Campus. LPA met with Director Teresa Valenzuela, and toured the facility indoors and outdoors.

The preschool consist of 3 classrooms: PK room (4-5 years olds), Room #2 (2 year olds), Room #3 (3 year olds). This is a part-time and full day program operating year round, 6:00AM to 6:00PM, Monday through Friday. The center provides an AM and PM lunch snack. Required licensing forms are posted on the parent's board.
Capacity and limitations as specified on the license are being maintained. The facility maintains a ratio of one teacher supervising no more than 12 children in care. All children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day
There were no bodies of water, firearms and/or ammunition on the premises. No poisons were observed during the inspection. Furniture and equipment were in good condition, free of sharp, loose or pointed parts. Playground equipment was in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space was maintained in a safe condition and was free of hazards. Areas around high climbing equipment and slides have cushioning material to absorb falls. Children's toilets and hand washing facilities were sanitary and in good operating condition. Floors in the facility were clean and safe. All kitchen, food preparation and storage areas were clean and free of litter/rubbish. All food was protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers had tight-fitting covers and were in good repair. Menus are posted at least one week in advance where an authorized representative can view them. Drinking water was available both indoors and outdoors. The facility had one or more functioning carbon monoxide detectors that meet statutory requirements.

Continued on LIC 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CRE8TIVE KIDS CAMPUS
FACILITY NUMBER: 153808946
VISIT DATE: 07/28/2021
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A sample of children's files were reviewed and contained contact information for authorized representative and/or relatives or others who can assume responsibility for the child and medical assessment. LPA also reviewed a sample of staff files and observed they contained health screening, immunization records for influenza, pertussis, and measles and current documentation of completed Mandated Reporter Training. At least one person trained in CPR and pediatric First Aid is present when children are at the facility or at off-site activities.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. Information regarding Amercians with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301 (voice), (800) 514-0383 (TDD) and website link https://ww.ada.gov/chilqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations no deficiencies were observed today.

Exit interview was conducted with Director Teresa Valenzuela. LPA provided Valenzuela with a copy of the Facility Evaluation Report (LIC 809) and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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