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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413746
Report Date: 08/25/2022
Date Signed: 08/25/2022 03:55:05 PM

Document Has Been Signed on 08/25/2022 03:55 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CREATIVE HABITAT CHILDREN'S CENTERFACILITY NUMBER:
434413746
ADMINISTRATOR:CHIA-HSIU CHANGFACILITY TYPE:
850
ADDRESS:1190 WEST LATIMER AVENUETELEPHONE:
(408) 374-4442
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 76TOTAL ENROLLED CHILDREN: 24CENSUS: 21DATE:
08/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Christina PulidoTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection at the day care facility today and met with Christina Pulido, Director.

LPA toured the indoor and outdoor areas with Director. The required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393) and Child Car Seat Law (PUB 269) are posted by the entrance area.

The preschool program are held in 3 rooms: Orange room (pre-k room), Red room (3 year old room) and Blue room (2 year old room). The classroom areas, furniture and equipment were observed to be clean and organized. There are age appropriate toys available for children. Fire extinguishers, fire alarm, smoke and carbon monoxide detectors and emergency first aid kit were observed throughout the building. The children's bathrooms were observed to be clean and sanitary. Chemicals and cleaning solutions are stored in the locked cabinets and inaccessible to children. Per Director, there are no poisons, weapons or firearms on the premises. Drinking water is readily available for the children indoor and outdoor via water filter. The rooms have solid waste containers with tight-fitting lids.

The day care facility provides breakfast, snacks and lunch for the children. LPA observed the kitchen area where food is prepared is free of litter and rubbish, rodents and vermins.

The outside playground area is surrounded by appropriate fencing and was observed to be safe and free of hazards. The outdoor play equipment are in good condition and the surface area has sufficient resilient materials. There are no bodies of water observed.

Continued on next page.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CREATIVE HABITAT CHILDREN'S CENTER
FACILITY NUMBER: 434413746
VISIT DATE: 08/25/2022
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LPA reviewed seven (7) children's files. Children's records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report and Immunization Record. The day care facility provides Incidental Medical Services (IMS). The children's medications are stored in a locked cabinet in the office area. The day care facility has an IMS plan on file.

LPA reviewed six (6) staff files. Staff records reviewed include Criminal Record Clearance, Immunization Record, CPR/First Aid, Mandated Reported Training, Qualifications and Education.

Per review of record, the center conducts emergency disaster drills every six months. Last drill conducted was in July 2022.

Director were reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Care providers are encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.



As a result of today's inspection, a deficiency has been cited. See LIC809D for deficiency. Exit interview conducted and report was reviewed with Director. A copy of the report and appeal rights form were provided.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/25/2022 03:55 PM - It Cannot Be Edited


Created By: James G Santos On 08/25/2022 at 03:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE HABITAT CHILDREN'S CENTER
FACILITY NUMBER: 434413746

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the day care facility did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Per record review, six (6) staff's Mandated Reporter Training certifications have expired in 2021.
POC Due Date: 09/23/2022
Plan of Correction
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Director stated staff will complete the Mandated Reporter Training for AB 1207 and submit proof of completion of training to CCL by POC due date of 9/23/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:James G Santos
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2022


LIC809 (FAS) - (06/04)
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