434400501-12-6-2022-07-CC-SYIP-CLUUWL-20221206145657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400501
Report Date: 12/06/2022
Date Signed: 12/06/2022 02:57:21 PM

Document Has Been Signed on 12/06/2022 02:57 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, 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: 47	DATE:	12/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Julie Nasiatka		TIME COMPLETED:	01:35 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 during today's inspection were 47 children and at least five (5) staff. The hours of operation are Monday through Friday 6AM to 6PM. LPA reviewed sign in/sign out sheet. License and notification of parent's rights were observed to be posted. LPA toured the inside and outside of the center with Director. LPA observed that there was a spray bottle with disinfectant spray on the shelf, which is accessible to children. Staff moved spray bottle to a shelf that is higher and out of reach of children. All other disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. There are toys and equipment for children, which were age appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 07/20/2022. Director stated that there are no weapons, such as firearms, stored on the premise. The outside area is fenced. Play equipment were observed to be in good condition. LPA reminded Director to dump out any water that collects. There were no bodies of water observed during today's inspection. Shaded rest area is provided through canopy. --------------------continues on 809 dated 12/06/2022 page 2----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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: 12/06/2022

NARRATIVE

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-------------------continuation of 809 dated 12/06/2022 page 1------------------

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA observed that C-1 and C-2's medication expired. Director followed-up with parent during today's inspection. Director will have parent updated forms to indicate that medication is no longer needed. For IMS information, see PIN 22-02-CCP.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

Facility only provides snacks to children. Snack menu was observed to be posted. Drinking water is provided through individual water bottles, Brita filters and cups. All meals are prepared and brought from home.

10 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and immunization records.

Six (6) staff's files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter training. There is at least one staff with a valid CPR/1st Aid, which expires on 11/15/2023. LPA discussed with Director that online CPR/1st Aid is not approved.

All staff present have cleared criminal record, child abuse index, or exemption. 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.

--------------------continues on 809 dated 12/06/2022 page 3---------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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: 12/06/2022

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------------------continuation of 809 dated 12/06/2022 page 2---------------------

At 12:08PM, LPA observed that a staff walked out of the Blue Room and walked towards the bathroom. LPA observed that there was no staff present to supervise children. Staff returned to the room at 12:10PM. LPA discussed with Director that children need to be supervised at all times, including visually. Director stated that there is window between Yellow Room and Blue Room. She stated staff in the Yellow Room was looking at the children in the Blue Room through window at the time.

LPA Samantha Yip informed Director Julie Nasiatka that this report dated 12/06/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Director, Julie Nasiatka, to provide a copy of this licensing report dated 12/06/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An updated LIC 610, LIC 200A, and LIC 310 was obtained during today's inspection.

Director will submit the following:
- facility roster which includes the address, datyime phone of parent/guardian, and date enrolled
- C-1's updated forms regarding not needing medication

As a result of this inspection, Type A was issued. A civil penalty of $500 was assessed for immediate $500. 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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/06/2022 02:57 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, 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: 12/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. LPA observed at 12:08PM that a staff walked out of the room; leaving children unsupervised.
	POC Due Date: 12/07/2022
	Plan of Correction
1 2 3 4	By POC 12/07/2022, Director will also submit a plan outlining how children will be supervised at all time. Director will conducted training with staff regarding supervision and send staff who received training.

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: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC809 (FAS) - (06/04)

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