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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434413745
Report Date: 05/28/2020
Date Signed: 05/28/2020 03:44:49 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2020 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20200304111148
FACILITY NAME:CREATIVE HABITAT CHILDREN'S CENTERFACILITY NUMBER:
434413745
ADMINISTRATOR:CHIA-HSIU CHANGFACILITY TYPE:
830
ADDRESS:1190 WEST LATIMER AVENUETELEPHONE:
(408) 374-4442
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:24CENSUS: 0DATE:
05/28/2020
ANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Chia-Hsiu ChangTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff is force feeding day care children.
Staff handled day care child in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Oscar Huang conducted an announced tele-inspection via FaceTime with Chai-Hsiu Chang, Licensee to deliver investigation findings. The facility is currently closed due to COVID-19 pandemic.
Based on information gathered from interviews with staff and LPA's own observations during the course of complaint investigation for the complaints listed above, LPA learned that a staff, even though was not having bad intentions, occasionally was force-feeding children, and at once by squeezing the child cheeks to open to feed. LPA therefore concludes that the preponderance of evidence standard has been met and the two allegations noted above are therefore SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1 number), are being cited on the attached LIC 9099-D. A notice of site visit was issued and posted near the facility entrance along with the Type "A" deficiencies and both notices must remain posted for 30 consecutive days. The Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months.
The department does not receive final reports from Campbell PD prior to deliver this investigation findings. If in the future, reports from them reveal information differently, the findings may be changed.
LPA Huang informed Licensee Chia-Hsiu that due to the COVID-19 shelter-in place order, today's Complaint Investigation Report (LIC 9099, 9099-D) along with AB633 Parents Notification, Appeal Rights, a copy of the Notice of Site Visit will be emailed to her (email: rachel.ch.chang@gmail.com) with a "read receipt" notification. The Licensee agreed to respond to LPA's email within 24 hours acknowledging receipt of today's report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 07-CC-20200304111148
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 HABITAT CHILDREN'S CENTER
FACILITY NUMBER: 434413745
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2020
Section Cited
CCR
101223(a)(3)
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Personal Rights: The licensee shall ensure that each child is accorded to be free from corporal or unusual punishment, infliction of pain, ..., or other actions of a punitive nature including but not limited to: interference with functions of
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Licensee to submit CCL plan of correction in written indicating methods and procedures implemented to ensure the facility stays in compliance with Tittle 22, Personal Rights, as well as to schedule a title 22 Personal Rights training for all staffs. A copy of agenda including names and signatures of staff who
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daily living including eating, sleeping or toileting; ..., or medication or aids to physical functioning. This requirement was not met as evidenced by LPA observed a staff was force-feeding children. This poses an immediately risk to the health and safety to the children in care.
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attended, shall also be sent to CCL by the first week the facility is reopen. AB633 Parent Notification is required. According to AB 633, all parents of children currently enrolled and any future children being enrolled for the next 12 months must be provided with this report which contains this type A deficiency.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020
LIC9099 (FAS) - (06/04)
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