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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622084
Report Date: 11/17/2022
Date Signed: 11/17/2022 01:14:18 PM


Document Has Been Signed on 11/17/2022 01:14 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:CREATIVE SPACES PRESCHOOL AND LEARNING CENTERFACILITY NUMBER:
343622084
ADMINISTRATOR:MONG, ELIZABETHFACILITY TYPE:
850
ADDRESS:5315 H STREETTELEPHONE:
(916) 307-7109
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:30CENSUS: 24DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Elizabeth MongTIME COMPLETED:
01:30 PM
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On Thursday, November 17, 2022 at 11:30 am, Licensing Program Analyst (LPA) Amanda Sutter met Director Elizabeth Mong for the purpose of an unannounced required annual inspection. LPA observed 24 children supervised by 5 staff. All individuals subject to criminal background review have obtained a criminal record clearance. The facility hours of operation are Monday through Friday from 7:30 AM to 5:30 PM.

LPA toured classroom spaces, restroom, kitchen, and outdoor play area. LPA observed the following documents are posted: License, Parents' Rights Poster, Seat Belt Law, menu, Earthquake Preparedness Checklist, and Emergency Disaster Plan. LPA observed a functional carbon monoxide detector. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. The program provides morning and afternoon snacks. LPA observed that there is limited visibility of the cubby space in the hallway from the classroom area upstairs. LPA discussed supervision requirements with Director.

LPAs observed trash bins with tight fitted lids. LPA observed the facility’s paper sign in and out system. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on October 13, 2022. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys, and shaded areas are supplied by trees and the building. Drinking water is readily available to children both indoors and outdoors. LPA observed that children bring their own water bottled and director stated that they are filled at the sinks in each classroom, Director stated that the water is filtered.

Four staff and seven children's records were reviewed. Both children and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate. PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CREATIVE SPACES PRESCHOOL AND LEARNING CENTER
FACILITY NUMBER: 343622084
VISIT DATE: 11/17/2022
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LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAS also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Service (IMS) policy was discussed. 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

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/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.

During today’s inspection, no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Elizabeth Mong.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
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