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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624646
Report Date: 10/29/2025
Date Signed: 10/29/2025 03:03:24 PM

Document Has Been Signed on 10/29/2025 03:03 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CREEKSIDE PRESCHOOL & INFANT CENTERFACILITY NUMBER:
343624646
ADMINISTRATOR/
DIRECTOR:		WRIGHT, KATHERINFACILITY TYPE:
840
ADDRESS:2550 BELPORT LANETELEPHONE:
(916) 333-1169
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 4DATE:
10/29/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Ginette StephensTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Kyrsten Williams and Pa Dao Vang met with facility owner, Ginette Stephens for an unannounced case management inspection of this school age facility. The purpose of this inspection was explained. Census included four children in care, being supervised by one staff member.

The facility has completed construction for the school-age playground. LPAs conducted a health and safety inspection of the outdoor activity space that will be used for school age children. The school age play area is surrounded by a metal fencing that is three feet and ten inches tall. LPAs observed a large fence surrounding the entire facility outdoor space is more than four feet tall. LPAs observed multiple play structures that are age-appropriate. LPAs observed a safety label on the largest structure specifying use is appropriate for children ages 5 years to 12 years old. LPAs advised facility owner to always follow consumer safety guidelines. The applicant was reminded to use age-appropriate equipment and toys. LPAs observed rubber cushion matts under the play structure that has enough resiliency material to absorb fall. LPAs observed sufficient shade for the outdoor space provided by trees and from the building. There is an additional concrete area the facility plans to use as a shared space for preschool children and school age children. LPAs advised facility owner a rotating shared space waiver must be submitted to request the space be shared between preschool children and school age children. Facility owner was reminded to inform the department prior to construction or alteration.

LPAs measured the outdoor activity space. The outdoor school age play area contains a total of 2340.39 square feet, which will accommodate the license's current capacity of 15 school age children. The additional concrete play area contains a total of 2138.09 square feet, which will be able to accommodate 28 children at one time.

PG. 1 - Report continues on LIC812-C
NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Kyrsten Williams
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CREEKSIDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 343624646
VISIT DATE: 10/29/2025
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Exit interview conducted and report was reviewed with the facility owner, Ginette Stephens. No deficiencies are cited today. A notice of site visit was given and must remain posted for 30 days.

The following corrections are needed prior to allowing children in the new play area:

1. Submit a request for a shared space waiver for the concrete play area and post the waiver.
NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Kyrsten Williams
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC809 (FAS) - (06/04)
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