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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598510
Report Date: 10/14/2019
Date Signed: 10/14/2019 03:44:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CREATIVE DAY ACADEMYFACILITY NUMBER:
191598510
ADMINISTRATOR:RENEE ESTRADAFACILITY TYPE:
850
ADDRESS:8740 RAMONA STREETTELEPHONE:
(562) 634-7527
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:94CENSUS: 48DATE:
10/14/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Renee Estrada, Director TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Rita Ramos and Alanna Gontarek conducted an unannounced case management inspection to the above facility. LPAs met with Renee Estrada, Director, who guided analysts on a tour of the facility. There were 48 napping children with 4 staff upon arrival.

During the inspection LPAs requested a copy of the facility roster, however, the Director was only able to provide LPAs with a roster that did not contain all of the required information. When LPAs requested a roster with all the required information, Director stated that they had to call an administrator to see if they can send one. LPAs advised the Director that a facility roster with all the required information needs to be readily available at the facility at all times.

Due to the facility not having the roster available for review and inspection during the inspection, the following deficiency is being cited in the attached deficiency page in accordance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Renee Estrada, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CREATIVE DAY ACADEMY
FACILITY NUMBER: 191598510
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2019
Section Cited

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Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and
the name and telephone number of the child's
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physician. This roster shall be available to the licensing agency upon request. This requirement is not met as evidenced by LPAs observing that the facility did not have a facility roster with the parents information and physician's information. This poses a potential risk to the health and safety of children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2019
LIC809 (FAS) - (06/04)
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