<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093621165
Report Date: 08/05/2021
Date Signed: 08/05/2021 11:21:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CREATION STATIONFACILITY NUMBER:
093621165
ADMINISTRATOR:WALKER, RHONDAFACILITY TYPE:
850
ADDRESS:3192 COUNTRY CLUB DRIVETELEPHONE:
(530) 672-0214
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:41CENSUS: 27DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rhonda WalkerTIME COMPLETED:
11:35 AM
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
On Thursday, 08/05/2021, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced annual random inspection for the facility. LPA met with Director Rhonda Walker. Upon arrival, LPA observed 27 children supervised by three staff members.

LPA conducted a health and safety inspection inside and outside of the facility. The following areas are in compliance during the visit. Firearms and ammunition are not on the premises. Director acknowledged that storage area for poisons needs to be locked and stated that there are no poisons on site. Disinfectants and hazardous items are inaccessible to children. Furniture and equipment are sufficient, age appropriate, and in good repair. Fire drills are conducted and documented. Carbon Monoxide detector was present and in working order. The playground equipment and outdoor activity space is maintained and in good condition. Gravel is being used as cushioning around the climbing equipment and level is sufficient to absorb a fall. Children's toilets, hand washing facilities are sanitary. Floors are clean and free of debris. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered, and all food or beverages are stored in covered containers and labeled. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Sign in/sign out sheets are maintained. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Some staff records were reviewed. Facility provides breakfast, lunch, and afternoon snack. Facility’s hours of operation are from Monday through Friday from 6:00 am to 6:00 pm.

LPA observed that two of the four staff do not have current Mandated Reporter training. Director stated that she understands that this training must be completed every two years for each staff.

REPORT CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CREATION STATION
FACILITY NUMBER: 093621165
VISIT DATE: 08/05/2021
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
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

LPA discussed current COVID guidelines with Director and emailed COVID-19 child care guidance and information. LPA observed that staff were wearing masks.

LPA discussed overdue licensing fees with Director. Director stated that she will inform the Owner.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Director can obtain updated licensing information, new regulations, and access forms. LPA advised Director of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

In the areas that were evaluated, a deficiency was observed at the time of the visit and cited on LIC 809-D. An exit interview was conducted and report was reviewed with Director who stated they understand today’s inspection. Notice of Site Visit was posted and Director understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CREATION STATION
FACILITY NUMBER: 093621165
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2021
Section Cited

1
2
3
4
5
6
7
On or before March 30, 2018, a person who. . . is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided. . . shall complete renewal mandated reporter training every two years
8
9
10
11
12
13
14
 following the date on which he or she completed the initial mandated reporter training.
This requirement was not met by: LPA observed that two of the four staff do not have current Mandated Reporter Training. This poses a potential risk to the health and safety of the children.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3