434400501-12-6-2021-07-CC-SYIP-C9FN55-20211206090857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400501
Report Date: 11/30/2021
Date Signed: 12/06/2021 09:09:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CREATIVE PLAY LEARNING CENTER		FACILITY NUMBER:	434400501
ADMINISTRATOR:	NASIATKA, JULIE		FACILITY TYPE:	850
ADDRESS:	95 FOURTH STREET		TELEPHONE:	(408) 846-9551
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	59	CENSUS: 46	DATE:	11/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Julie Nasiatka		TIME COMPLETED:	02:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Director Julie Nasiatka and explained the reason for the inspection. Present were 6 staff, 46 children, and one volunteer. Upon arrival, Director informed LPA that is usually in the classroom, since she is training a new staff (S-1). LPA observed that S-1 was with the children, but has not completed at least 6 semester units yet. There was a room adjacent that a fully qualified staff can visually observe children. LPA discussed with Director to inform LPA if she needs to be in ratio if there is no fully qualified teacher present. There is area to post required postings, such as license and notification of parent's rights. LPA also observed that Car Seat Law was posted. LPA reminded Director to ensure that Emergency Disaster Plan is up to date. The hours of operation are Monday through Friday 7AM to 5:30PM. There is working phone at the facility. LPA toured in the inside and outside of the facility with Director. The facility was observed to be clean. All furniture were observed to be in good condition. Disinfectants and cleaning supplies were observed to inaccessible to children. LPA reminded Director that any hand sanitizer or anything that states to keep out of reach of children needs to inaccessible. There is a fully charged fire extinguisher and carbon monoxide detector. The facility has fire sprinklers. Director stated that there are no weapons, such as firearms, stored on the premise. LPA reminded Director to document fire drills. The outside area is fenced. All play equipment were observed to be in good condition. LPA ----------------------CONTINUES ON 809 DATED 11/30/2021 PAGE 2-----------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE PLAY LEARNING CENTER	FACILITY NUMBER: 434400501
	VISIT DATE: 11/30/2021

NARRATIVE

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--------------------CONTINUATION OF 809 DATED 11/30/2021 PAGE 1-------------------------

reminded Director to make sure she is wiping any play structure down for sand that collect on the steps or walkways . Shaded rest area is provided through the canopy. There were no bodies of water observed during today's inspection.

The facility only provides snacks to the children. There is a kitchen to prepare and store snacks. All meals are prepared and brought from home. Snack menu was observed to posted for the month. Drinking water inside and outside is provided through Brita filter and individual water bottles. Director stated that she just purchased a new water fountain, which she will have it installed outside. LPA reminded Director to ensure that children have access to drinking water outside.

This facility provides Incidental Medical Services-(IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Section 101173 and 101226. 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.

10 children's file were reviewed during today's inspection. The records reviewed include but not limited to emergency contact card and physicians report.

Six (6) staff files were reviewed during today's inspection. The records reviewed include but not limited to transcript, Mandated Reporter training, and immunization records. LPA observed that all staff did not have a current Mandated Reporter training certificate on file. LPA reminded Director that the Mandated Reporter training requires renewal every two years. Mandated Reported Training can be accessed at
http://www.mandatedreporterca.com.

------------------CONTINUES ON 809 DATED 11/30/2021 PAGE 3---------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE PLAY LEARNING CENTER	FACILITY NUMBER: 434400501
	VISIT DATE: 11/30/2021

NARRATIVE

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---------------------CONTINUATION OF 809 DATED 11/30/2021 PAGE 2-------------------------

LPA also reminded Director that all staff have a currently proof of influenza or decline of flu shot on file. All staff have a valid CPR/1st Aid. Director's CPR/1st Aid expires on 08/2022.

All staff present have cleared criminal record clearance. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Director stated that she is going to have volunteer get fingerprinted, but comes in to help with paperwork.

LPA discussed with Director about COVID guidelines and requirement for children to wear face covering.

As a result of this inspection, a Type B citation and technical assistance were issued. Exit interview conducted and report was reviewed with Director Julie Nasiatka. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC809 (FAS) - (06/04)

Page: 6 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE PLAY LEARNING CENTER	FACILITY NUMBER: 434400501
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/30/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above. All staff did not completed Mandated Reporter training within 2 years, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/17/2022
	Plan of Correction
1 2 3 4	By POC 01/17/2021, Director stated that she will have staff complete training and send proof to Licensing.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC809 (FAS) - (06/04)

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