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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100405182
Report Date: 06/06/2019
Date Signed: 06/07/2019 03:39:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:DERMER'S CREATIVE CAREFACILITY NUMBER:
100405182
ADMINISTRATOR:DERMER, ADAMFACILITY TYPE:
850
ADDRESS:321 W. HERNDON AVENUETELEPHONE:
(559) 435-2901
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY:77CENSUS: 20DATE:
06/06/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Adam DermerTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced plan of correction (POC) inspection and met with Director, Adam Dermer to verify plan of corrections for deficiencies that were cited on May 2, 2019. LPA discussed the purpose of the inspection and a tour of the center was conducted. Adam Dermer Provided LPA with Teacher #1 and Teacher #2 transcripts and Teacher #2 and Teacher #3's immunization's. Adam Dermer rewrote the plan of correction regarding the criminal record clearance deficiency and stated that this will not happen again.

Based on observations of the documents, LPA determined the facility corrected all deficiencies.

Per California Code of Regulations Title 22, Division 12, no deficiencies cited during today's inspection.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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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