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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410803
Report Date: 05/30/2019
Date Signed: 06/03/2019 03:19:53 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 CENTERFACILITY NUMBER:
434410803
ADMINISTRATOR:RICHA D. KAPURFACILITY TYPE:
830
ADDRESS:4977 DENT AVENUETELEPHONE:
(408) 445-0101
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:14CENSUS: 5DATE:
05/30/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Richa KapurTIME COMPLETED:
04:15 PM
NARRATIVE
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LPA Janet Tse met with director Richa Kapur for a Plan of Correction inspection. LPA explained the nature of today's inspection to the director. LPA observed four napping infants in the nap room with two teachers, and one active infant in the infant room with one teacher.

LPA observed an exposure notice dated 05/28/2019 from the Health Department from the County of Santa Clara to the parents about the Hand, Foot, and Mouth Disease. Director did not report the incident to Licensing by phone within 24 hours of the occurrence as required. LPA provided the Director Title 22 regulation section 101212 Reporting Requirements for her review. Director stated that she will submit the written incident report LIC 624 to Licensing today. LPA observed the Notice of Site Visit was posted; however, the report with type A deficiency cited on 05/16/2019 was not posted. Director stated that the Infant Program only uses the playground in the back of the facility. The information was confirmed by a staff. LPA reviewed 11 children's files and observed a copy of the LIC 9224 Acknowledgement of Receipts of Licensing Reports with parents' signatures for the type A deficiency cited on 05/16/2019 in each child's file except for child #11 who is on vacation.

Deficiency was cited. Civil penalty of $100 was assessed. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
HSC
1596.8595(a)
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Each licensed child day care facility shall post a copy of any licensing report pertaining to the facility that documents either a facility visit or a complaint investigation that results in a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care...
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Director shall immediately post the report with type A deficiency cited on 05/16/2019 with the Notice of Site Visit for 30 days.

Civil penalty of $100 is assessed.

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This requirement was not met as evidenced by:
LPA observed the Notice of Site visit was posted; however the report with type A deficiency cited on 05/16/2019 was not posted.

This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Director posted the report toward the end of today's inspection. Deficiency is cleared today.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
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