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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620781
Report Date: 11/01/2019
Date Signed: 11/01/2019 03:20:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CREATIVE CHILD CARE @ DON AVENUE CDCFACILITY NUMBER:
393620781
ADMINISTRATOR:EISON, DEBRAFACILITY TYPE:
850
ADDRESS:8121 DON AVENUETELEPHONE:
(209) 956-2686
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:109CENSUS: 49DATE:
11/01/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Mayra Madigral TIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection at the above facility regarding an incident report submitted to Community Care Licensing concerning supervision of children in care. LPA met with Site Supervisor Mayra Madigral. LPA observed 49 children supervised by 12 staff.

LPA toured the facility. LPA conducted interviews with childcare center staff. LPA obtained child #2's parent contact information. Based on the information received during today's inspection it was determined there was not a lack of supervision associated to the incident. Medical precaution was taken for child #2 at the parent's discretion. Child #2 returned to the center and appeared to be doing well. The center has since discussed classroom safety precautions with students and staff.

Exit interview conducted. Notice of site visit provided with appeal rights to Site Supervisor .
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
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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