434410803-5-16-2019-07-CC-JTSE-BC9375-20190516175921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410803
Report Date: 05/16/2019
Date Signed: 05/16/2019 05:59:36 PM

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 MINDS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434410803
ADMINISTRATOR:	RICHA D. KAPUR		FACILITY TYPE:	830
ADDRESS:	4977 DENT AVENUE		TELEPHONE:	(408) 445-0101
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 6	DATE:	05/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Richa Kapur		TIME COMPLETED:	06:00 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), Janet Tse, conducted an unannounced annual/random inspection to the facility today. LPA met with Richa Kapur, licensee/director, and explained the nature of today’s visit to her. LPA toured the facility both indoor and outdoor during today’s visit. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents’ Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. The Facility has an active waiver for shared playground use with the preschool program. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 05/15/2019 was reviewed; and it indicates that all facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA observed the medical assessment and the Information and Emergency Information form (LIC 700) in six children’s files. LPA observed there is a current Infant Service and Need Plan for each child. LPA observed the required health screening (LIC 503) in three staff files. Staff current CPR and First Aid Certifications are in file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed the required immunization records per SB792 are in each staff's file. Certifications for completion of Mandated Reporter AB1207 Compliant Child Care Training are in each staff's file. LPA observed that the teacher/child ratio was in compliance during today’s inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. LPA reviewed the sign-in, sign-out sheets for the past 30 days. LPA obtained a copy of the roster of the children. LPA observed five sleeping infants with one teacher assistant in the nap room, and one active infant with two teachers in the indoor play area in Room 1 (Green Room). Facility Evaluation Report dated 05/16/2019 to be continued on next page: Page 1

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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

FACILITY NAME: CREATIVE MINDS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434410803
	VISIT DATE: 05/16/2019

NARRATIVE

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Facility Evaluation Report dated 05/16/2019 to be continued from previous page:

and decrease of capacity of the infant program. The waiver for shared playground use with the preschool program issued on 08/20/2012 only applies to the playground in the back of the facility. LPA did not observe any bodies of water.

LPA discussed Zero Tolerance with $500 immediate civil penalty; and an ongoing $100 per day per violation continues until the violation(s) is corrected. Information on Safe Sleep practice and Lead Poisoning was provided to Director.

LPA discussed the requirements of AB633 to licensee/director and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee/director understands the requirements. Upon receipt, licensee/director shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Title 22 Regulations and Information can be obtained through the internet at www.cdss.ca.gov. LPA conducted an exit interview with Director prior to the conclusion of today’s visit.

Deficiency was cited. Immediate civil penalty of $500 was assessed for zero tolerance violation. Notice of site visit was issued and must be posted with type A deficiency cited for 30 days.

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SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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 MINDS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434410803
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/17/2019 Section Cited CCR 101171(a)	1 2 3 4 5 6 7	Fire Clearance. All child care centers shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director must cease using the side playground for the infant program until fire clearance is obtained. Director shall submit LPA by 05/17/2019 due date an application for change of playground usage, together with an updated facility sketch, both indoor and outdoor, and also the activity schedules of each room of the preschool and infant programs.
	8 9 10 11 12 13 14	LPA observed children from the infant program playing in the side playground during the inspection for the preschool program earlier today. The side playground did not obtain fire clearance and was not licensed for the infant program. This poses an immediate risk to the Health, Safety, or Personal Rights of children in care.	8 9 10 11 12 13 14	Upon receipt of the application and facility sketch, fire clearance will be ordered by Licensing. This is a zero tolerance violation. Immediate civil penalty of $500 is assessed. AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
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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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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 MINDS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434410803
	VISIT DATE: 05/16/2019

NARRATIVE

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Facility Evaluation Report dated 05/16/2019 to be continued from previous page:

LPA observed that the room is clean and safe for all children and staff. Director states that the facility has a third-party cleaning service that cleans the facility during the week days in the evenings. Drinking water is
readily available for the children in each room and in the outdoor playground area via water bottles and filtered water in jugs. LPA observed solid waste containers with tight-fitting lids the room and in the playground area. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children. Sick infants are isolated area in the day care room separated from the rest of the children, and parents will be notified to pick up the child immediately. Director stated that there are no weapons on the premises.

The food preparation area is adequately equipped with ovens, refrigerators, and hot and cold running water. There is also adequate food for snacks for the children. Children bring their own meal, snacks, and formula. Cleaning supplies are stored inaccessible to the children. Any medications at the Facility are stored appropriately and in the off-limits kitchen area of the facility. LPA reviewed the Facility’s medicine log and medication lock box during today’s visit.

LPA observed all furniture and equipment is in good condition and safe for the children. Per the facility evaluation report dated 08/15/2012 for a case management inspection for change of capacity from 38 to 14 infants, and per the facility sketch for fire clearance, the infant playground is the outdoor area in the back of the facility building. The facility evaluation report stated, "The outdoor play area is in the back of the facility building and is appropriately fenced. LPAs observed there is a sand box, play structure and bikes in the playground. There are adequate wood chips for resilient material. The shade is provided by trees and building awning." It depicts the area "Infant/Play area - Shared with Preschool" on the facility sketch for fire clearance. Director stated the infant program is currently using the play area in the back as well as the side preschool playground. LPA also observed children from the infant program playing in the side playground during the inspection for the preschool program earlier today. Licensing was not notified of the change of usage of playgrounds. The side playground did not obtain fire clearance for the infant program and was not licensed for the infant program. It is licensed and has fire clearance for the preschool program only. Prior to the decrease of capacity, the side playground was previously used for the infant program as indicated in the facility evaluation report dated 06/21/2010; but it has been changed for the preschool usage exclusively after the removal of the toddler program and decrease of capacity in August 2012. The side playground has been replaced with new equipment and play structure. The preschool program uses all three playgrounds.

Facility Evaluation Report dated 05/16/2019 to be continued on next page: Page 2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

LIC809 (FAS) - (06/04)

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