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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393605031
Report Date: 01/30/2020
Date Signed: 01/30/2020 06:09:53 PM

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 CHILD CARE, INC.@CREATIVE HEAD STARTFACILITY NUMBER:
393605031
ADMINISTRATOR:SHAWNETTE GLADNEYFACILITY TYPE:
850
ADDRESS:7505 TAM O'SHANTERTELEPHONE:
(209) 956-2686
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:144CENSUS: DATE:
01/30/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Shawnelle GladneyTIME COMPLETED:
06:08 PM
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Licensing Program Analyst (LPA) Aruna Sridharan met with Director Shawnelle Gladney for the purpose of annual inspection. Today's census was 20 toddlers and 52 preschoolers with 16 staff members.

LPAs toured the building including toddler classrooms 6A, 6B, 7 and preschool rooms 1,2,and 3 restrooms and outdoor play area. LPAs observed appropriate ratios, care and supervision, and capacity during the visit. The hours of operation are Monday through Friday 7:00am to 5:30pm. The facility provides am/pm snack and lunch which is cooked off site.

Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. First Aid was centrally located but inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with wood chips to absorb falls. There are 2 toilets and 2 sinks in each classroom. Toileting facilities were in operating, safe, and sanitary condition. Uncontaminated drinking water is readily available to children both indoors and outdoors. LPA observed a current menu posted. LPA observed Sign In/Out Sheet with signatures, times, and dates. The facility conducts fire drills along with the school district per record the last drill was conducted 12/19. The children's roster was current and updated for both classrooms.
LPA reviewed 15 children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative.

Report continues on 809C page......
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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 4
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 CHILD CARE, INC.@CREATIVE HEAD START
FACILITY NUMBER: 393605031
VISIT DATE: 01/30/2020
NARRATIVE
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At least one staff member present today had current Pediatric CPR and First Aid certification (expires 06//21). Some staff are missing proof of immunizations. This is a potential risk to the health and safety of children in care, hence a Type B citation. LPA also reviewed documentation of qualifications including education and experience. All staff members have mandated reporter(AB1207) training completed Certificates are on file.
LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident. One staff member is not associated with the facility which is immediate risk to the safety of chidren in care. Civil Penalty is assessed.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.
LPA discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is currently providing IMS; however, LPA discussed the IMS policy. For IMS information see the Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and Medication Regulations 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), 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: www.ada.gov/childqanda.

Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report and provided copies to the facility. An exit interview was conducted. Appeal Rights were provided and Notice of Site Visit posted and the director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CREATIVE CHILD CARE, INC.@CREATIVE HEAD START
FACILITY NUMBER: 393605031
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2020
Section Cited

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The day care center shall maintain documentation of the required immunizations,....record that is maintained by the day care center. This was not evidenced by;
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LPA reviewed the staff files and found that some staff files were missing documentation of immunizations as per the health and safety code.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 CHILD CARE, INC.@CREATIVE HEAD START
FACILITY NUMBER: 393605031
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2020
Section Cited

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Prior to working or volunteering in a licensed chiold care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline.
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LPA reviewed personnel roster and observed staff 1 not associated to the facility. This poses immediate health and safety risk to the 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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4