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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203223
Report Date: 12/21/2023
Date Signed: 12/21/2023 05:37:49 PM


Document Has Been Signed on 12/21/2023 05:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CREATIVE BEGINNINGS IIFACILITY NUMBER:
426203223
ADMINISTRATOR:SMITH, SALLY ANNEFACILITY TYPE:
850
ADDRESS:240 PINAL AVE.TELEPHONE:
(805) 938-1976
CITY:ORCUTTSTATE: CAZIP CODE:
93455
CAPACITY:48CENSUS: 10DATE:
12/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:31 PM
MET WITH:Sara MooreTIME COMPLETED:
06:00 PM
NARRATIVE
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On 12/21/2023, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management inspection and met the Lead Teacher, Johna Emerick LPA discussed the purpose of the inspection. There were no children present. Last child was picked around 5:00 PM

On 10/4/2023, Licensing Program Analyst (LPA) Susana Martinez conducted a review of the 9/29/2023 sign-in/sign-out logs for both children and staff members. Upon review, it was determined that the sign-in/sign-out log documented 17 children within the premises between 12:00-12:30 PM. On the other hand, the staff sign-in/sign out records indicated only 2 staff members during the same period.

LPA Martinez conducted interview with Staff 1 to ensure the accuracy of the findings obtained through the review of documents. The interview corroborated the information obtained from the sign-in/sign-out document. Interview revealed that while two children were accompanied in the bathroom by S1, one teacher was overseeing a group of 15 children outside during the same period.

Based on record review and interview conducted, a deficiency was cited under Title 22 Division 12 of California Code of Regulation. Deficiency was documented on LIC 809 D.

Exit interview conducted and evaluation report was reviewed with Johna Emerick.
Appeal Rights were given . Notice of site visit was issued.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
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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Document Has Been Signed on 12/21/2023 05:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CREATIVE BEGINNINGS II
FACILITY NUMBER: 426203223

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
CCR
101216.3(a)

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Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

This requirment is not met as evidenced by:
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Ms. Emerick agreed to submitted a written plan of correction (POC) no later than 12/29/2023 on how to ensure that CCC adheres to the Teacher-Child Ratio regulation.
gigi.reyes@dss.ca.gov
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9/29/2023 Sign-in/Sign-out logs for children and staff members documented that there were 17 children and 2 staff present during the time frame of 12:00 PM - 12:30 PM. Interview with Staff 1 revealed that 15 children were out in the playground under the care of 1 staff (Staff2) while 2 other children were inside under the supervision of Staff 1 This poses a potential risk to health and safety of 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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
LIC809 (FAS) - (06/04)
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