434413746-10-23-2024-07-CC-FCJO-DABURP-20241023154904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413746
Report Date: 10/23/2024
Date Signed: 10/23/2024 03:49:13 PM

Document Has Been Signed on 10/23/2024 03:49 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CREATIVE HABITAT CHILDREN'S CENTER		FACILITY NUMBER:	434413746
ADMINISTRATOR/ DIRECTOR:	CHIA-HSIU CHANG		FACILITY TYPE:	850
ADDRESS:	1190 WEST LATIMER AVENUE		TELEPHONE:	(408) 374-4442
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY: 76	TOTAL ENROLLED CHILDREN: 41	CENSUS: 27	DATE:	10/23/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Christina Pulido		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Jaime Gonzales met with Christina Pulido who is the acting Site Director (SD) for an unannounced annual Inspection. LPAs toured the indoor and outdoor areas of the Facility during today's inspection. LPAs observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menu, Activity Schedule. Days and hours of operation are Monday through Friday 6:00 am to 6:00 PM. LPA reviewed six children's and three staff files during today's inspection. Each child's file reviewed contains the required documents; including the Information and Emergency Information form (LIC 700) and immunization records. Not all the staff files reviewed contain the required documents; including transcripts/verification of experience/immunization records, and Health Screening Report. All the staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on 6/10/24. The Site Director and the staff have current CPR and First Aid certifications on file. Site Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's inspection. Site Director understands the conditions, limitations, and capacity specifications of the Facility. SD understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the little area behind the reception desk. **************************Report dated 10/23/24 continues on page 2

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

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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Document Has Been Signed on 10/23/2024 03:49 PM - It Cannot Be Edited

Created By: Fermin Campos-Jaramillo On 10/23/2024 at 02:40 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: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review the licensee did not comply with the section cited above, LPAs observed that one staff member need proof of immunization for measles,this poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	Site Director shall submit to Licensing Program proof of immunization for measles for staff Patricia Erwin not later than 11/06/24.

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above, the center was unable to produce the health screening report for Samantha Hodges which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	Site Director shall submit no later than November 6, 2024 a copy of the Health screening form Lic503 for Samantha Hodges.

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:

Susy Cervantes

LICENSING EVALUATOR NAME:

Fermin Campos-Jaramillo

LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE HABITAT CHILDREN'S CENTER	FACILITY NUMBER: 434413746
	VISIT DATE: 10/23/2024

NARRATIVE

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****************Report dated 10/23/24 continues from page 1.
LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. The Facility has adequate ventilation, including central air conditioning/heating. SD states that the school staff do the cleaning by the end of the shift. Site Director understand that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children.
Drinking water is readily available for the children in the Facility (indoor/outdoor) via water bottles that children bring from home. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. SD states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in the Facility.
The Facility provides breakfast, lunch and snacks which are prepared in the kitchens of the center. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored inaccessible to children. SD states that there are no poisons in the Facility. LPAs observed a complete First Aid kit in the Facility. SD states that the Facility does not administer any medications at this time. SD understands that smoking is not allowed on the Facility premises.
The facility has a Incidental Medical Services (IMS) plan in file. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is a secure play structure that is age appropriate for the preschool children.

Report dated 10/23/24 continues on page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE HABITAT CHILDREN'S CENTER	FACILITY NUMBER: 434413746
	VISIT DATE: 10/23/2024

NARRATIVE

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Report dated 10/23/24 continues from page 2.

There is sufficient cushioning materials (wood chips) under and surrounding the play structure. Shade is provided by tall trees. LPA did not observe any bodies of water. SD states that the Facility does not provide transportation.

A review of staff records on 10/22/24 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Site Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Site Director.

Two type B deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC809 (FAS) - (06/04)

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