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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393620780
Report Date: 08/28/2019
Date Signed: 08/28/2019 02:22:50 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2019 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20190822150819
FACILITY NAME:CREATIVE CHILD CARE @ DON AVENUE CDCFACILITY NUMBER:
393620780
ADMINISTRATOR:EISON, DEBRAFACILITY TYPE:
830
ADDRESS:8121 DON AVENUETELEPHONE:
(209) 956-2686
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:12CENSUS: 9DATE:
08/28/2019
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Mayra Madrigal TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Staff failed to provide comfortable temperatures for day care children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stacey Williams arrived at the childcare center to initiate a complaint investigation. LPA met with Site Supervisor, Mayra Madrigal. LPA toured the facility and observed nine (9) infants supervised by three staff.
LPA made observations during today's inspection. The facility appeared to be in good repair and at a comfortable room temperature of 69 degrees in the infant room. LPA discussed the allegation with Site Supervisor. Site Supervisor acknowledged the air conditioner was inoperable in the infant room from August 22, 2019- August 23, 2019. Site Supervisor reported the Director was notified of the air conditioner malfunction. The maintenance technician was contacted and the unit was serviced on August 23, 2019. Site Supervisor reported the temperature reached 85 degrees in the infant room and she shifted the infants into a different room and combined the preschool program while ensuring ratio was met. Site Supervisor acknowledged Community Care Licensing was not informed of the incident. Based on the information received, the allegation is substantiated. Title 22 deficiencies cited on subsequent page, LIC9099D.

Exit interview conducted . Notice of site visit provided, copy of personal rights regulation and appeal rights were given to the Site Supervisor.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797-
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 53-CC-20190822150819
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 @ DON AVENUE CDC
FACILITY NUMBER: 393620780
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited
CCR
101223(a)(2)
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The licensee shall ensure that each child is accorded the following personal rights. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Site Supervisor notified the Director once she was aware of the air conditioner malfunctioning. The facility's maintenance technician was notified and the unit was fixed on August 23, 2019. The air conditioner is currently functioning throughout the facility. Therefore the deficiency is cleared.
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This requirement was not met as evidenced by: Site Supervisor acknowledged the air conditioner was malfunctioning from August 22, 2019-August 23, 2019 leaving the infant room temperature at 85 degrees. This is a potential immediate risk to the health and safety of children in care.
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Site Supervisor will notify Community Care Licensing of any future physical plant malfunctions that will impact children in care's personal rights to be in a safe and comfortable environment.
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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797-
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2