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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393605031
Report Date: 11/04/2019
Date Signed: 11/04/2019 02:33:53 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: 50DATE:
11/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Shawnette GladneyTIME COMPLETED:
02:40 PM
NARRATIVE
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At 11:30am Licensing Program Analysts (LPAs) Aruna Sridharan and Christopher Jackson met with the director Shawnette Gladney for today's inspection to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 10/18/19. During today's inspection the facility was toured. Present were 50 children in care and 9 staff.

During today's inspection LPAs interviewed the Director and four teachers regarding the incident. The facility reported the UIR to Community Care Licensing within 24 hours.It was reported around 10:30 am, on 10/17/19 one child was left on the playground unsupervised. As class#2 was transitioning inside after outdoor play time a child left the group and laid on the slide located to the back of the play area. When class#3 was transitioning out for play the staff noticed the child on the slide with no teachers present. The class#2 teacher was notified immediately by classs #3 staff and the child was brought back into the classroom. LPAs observed the director to have a written plan with staff detailing the supervision of children in care. The plan was drafted on 10/23/19 after the incident occurred and was reported to CCLD. LPAs reviewed and discussed this report with the Director.

The following Title 22 Deficiency is being cited on the subsequent 809-D page. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 809-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809-D in each child's file. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit 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: 11/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2019
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, 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: 11/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2019
Section Cited

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101229(a)(1) Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by;
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Based on the unusual incident report and interviews, a child was left without supervision on 10/17/19.
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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: 11/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2019
LIC809 (FAS) - (06/04)
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