393621289-8-12-2019-53-CC-SDLA-BEYS6E-20190812133549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393621289
Report Date: 08/12/2019
Date Signed: 08/12/2019 01:35:54 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 @ WIDMER CDC		FACILITY NUMBER:	393621289
ADMINISTRATOR:	DEBRA ADAFOM		FACILITY TYPE:	850
ADDRESS:	751 STONEBRIDGE LANE		TELEPHONE:	(209) 941-9100
CITY:	LATHROP	STATE: CA	ZIP CODE:	95330
CAPACITY:	24	CENSUS: 23	DATE:	08/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Josefina Cervantes		TIME COMPLETED:	02:00 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Seychelle De Luca and Alecia Sifuentes met with Site Supervisor Josefina Cervantes for the purpose of an unannounced annual random inspection. Site Supervisor was reminded never to exceed the conditions, limitations and capacity specified on the license. LPAs observed 23 preschool children supervised by Site Supervisor and two fully qualified teachers. Facility hours of operation are Monday through Friday from 8:15 AM to 11:15 PM and 12:30 to 3:30 PM in Room 20. Facility follows the school calendar.

LPAs toured Room 20, restroom, and an outdoor play area. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, menus, and daily schedule. LPAs observed a first aid kit. Cleaning disinfectants, hazardous items, and medications are appropriately stored and inaccessible to children. Site Supervisor stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter, all food was protected against contamination, and storage containers with solid waste have tight-fitting covers. Program provides morning and afternoon snacks.

Drinking water was readily available to children both indoors and outdoors. LPAs observed full legal signatures while reviewing the sign in and sign out sheet. Playground equipment and surfaces are free of loose or sharp parts. There is a sufficient amount of bark beneath the climbing structure. There are shaded areas supplied by an overhang.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

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 @ WIDMER CDC	FACILITY NUMBER: 393621289
	VISIT DATE: 08/12/2019

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Three staff and four children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 08/2019). All staff currently employed with the facility have a criminal record clearance, health screening report, immunization records, Mandated Reporter training certificates, and documentation of the educational background, training, and/or experience. LPAs reminded Site Supervisor that 100% supervision is required at all times, including in the bathroom. There are no firearms or bodies of water on the premises. LPAs reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

Incidental Medical Services (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.

LPAs verified the annual fees are current. LPAs provided and discussed Healthy Schools Act survey, Effects of Lead Exposure brochure, and new immunization card.

This facility evaluation report was reviewed and discussed with Site Supervisor. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Site Supervisor was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

LIC809 (FAS) - (06/04)

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