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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410803
Report Date: 01/10/2020
Date Signed: 01/10/2020 03:57:01 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:16CENSUS: 4DATE:
01/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Richa KapurTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Dung Mac and Melvin Matos met with Richa Kapur, Licensee representative/director, for an unannounced case management inspection.

LPAs reviewed one staff file during today's inspection. LPAs reminded Richa that she must retain copies of personnel records for a period of up to three years after separation of service.

A review of staff records on January 10, 2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Richa of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

No deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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