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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093621165
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:56:22 PM


Document Has Been Signed on 09/14/2023 03:56 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: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: 25DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rhonda WalkerTIME COMPLETED:
11:00 AM
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) met with Director Rhonda Walker, for an unannounced annual inspection of this preschool facility. LPA toured the facility, including all activity and classroom spaces, restrooms, and outdoor play area. Census included 25 children in care with 3 staff. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are 6:00 AM to 6:00 PM, Monday to Friday

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.

Classrooms observed are clean, including the carpets and floor. Chemicals were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Children bring their own water bottles daily from home, and is refilled in the facility as needed. The facility provides breakfast, lunch, and snacks. LPA observed a posted menu and observed food stored at safe temperatures.

Bathrooms were sanitary and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. LPA observed all required licensing documentation was posted for parental review. LPA observed that parents are signing their children in and out of the center.



continued on LIC809C...

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CREATION STATION
FACILITY NUMBER: 093621165
VISIT DATE: 09/14/2023
NARRATIVE
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LPA reviewed with Director the LIC311A, Records to Be Maintained at The Facility, for child's records, personnel records, administrative records, and documents to be posted. Children’s and staffs' files were reviewed. Each child's file had the required licensing documentation. LPA reviewed staff transcripts and observed all staff caring for children were qualified. At least one staff had a current Pediatric CPR and First Aid certification. Staff have current Mandated Reporter certificates. Technical assistance provided regarding proof of immunizations and health screening. LPA observed a current children's roster and a fire drill log which was last conducted on 9/7/23. There is First Aid equipment available.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. • CCC TESTING DEADLINE HAS NOT PAST. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

continued on LIC809C...
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CREATION STATION
FACILITY NUMBER: 093621165
VISIT DATE: 09/14/2023
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process. Director was informed of the https://mychildcareplan.org/; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Tittle 22 deficiencies were cited during today's inspection. This report was reviewed with Director, and an exit interview was conducted. A Notice of Site Visit (NOS) was provided to Director, who will post it for a period of 30 days for parental review.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/14/2023 03:56 PM - It Cannot Be Edited

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: CREATION STATION
FACILITY NUMBER: 093621165

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023

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
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 3 staff files did not have required immunizations on file for LPA review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
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Director stated staff will get a copy from their health care provider. Director stated she will email LPA attestation statement that they have placed a copy in staff files with the required immunizations by 4PM on POC due date. Director will email LPA if she needs more time.
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
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 3 staff files did not have LIC503 Health Screening Report on file for LPA review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
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Director stated staff will get a copy from their health care provider. Director stated she will email LPA attestation statement that they have placed a copy in staff files with the required health screening report by 4PM on POC due date. Director will email LPA if she needs more time.
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: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
LIC809 (FAS) - (06/04)
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