434413745-9-6-2022-07-CC-JGSS-CHZRSZ-20220906131735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413745
Report Date: 09/06/2022
Date Signed: 09/06/2022 01:17:51 PM

Document Has Been Signed on 09/06/2022 01:17 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 HABITAT CHILDREN'S CENTER		FACILITY NUMBER:	434413745
ADMINISTRATOR:	CHIA-HSIU CHANG		FACILITY TYPE:	830
ADDRESS:	1190 WEST LATIMER AVENUE		TELEPHONE:	(408) 374-4442
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	24	CENSUS: 6	DATE:	09/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Christina Pulido		TIME COMPLETED:	01:30 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), James Santos conducted an unannounced Required 1 Year inspection at the day care facility today and met with Christina Pulido, Director. LPA toured the indoor and outdoor areas with Director. The required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393) and Child Car Seat Law (PUB 269) are posted by the entrance area. The infant program is held in 2 rooms: Green and Yellow rooms. The classroom areas, furniture and equipment were observed to be clean and organized. There are age appropriate toys available for children. The rooms are equipped with refrigerators for milks and formulas, microwave ovens and sinks. LPA also observed sippy bottles for the children. The rooms have solid waste containers with tight-fitting lids. Fire extinguishers, fire alarm, smoke and carbon monoxide detectors and emergency first aid kit were observed throughout the building. Chemicals and cleaning solutions are stored in the locked cabinets and inaccessible to children. Per Director, there are no poisons, weapons or firearms on the premises. The day care facility provides meals for the children and others bring meals from home. LPA observed the kitchen area where food is prepared is free of litter and rubbish, rodents and vermin. The outside playground area is surrounded by appropriate fencing and was observed to be safe and free of hazards. The outdoor play equipment are in good condition and the surface area has sufficient resilient materials. There are no bodies of water observed. *Continued on next page.*

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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 HABITAT CHILDREN'S CENTER	FACILITY NUMBER: 434413745
	VISIT DATE: 09/06/2022

NARRATIVE

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LPA reviewed children's files. Children's records reviewed include Needs and Services plan, Individual Sleeping Plan and Sleep log. LPA reviewed staff files. Staff records reviewed include Criminal Record Clearance, Immunization Record, CPR/First Aid, Mandated Reported Training, Qualifications and Education.

The day care center provides Incidental Medical Services (IMS). The children's medications are stored in a locked cabinet in the office area. The day care center has an IMS plan on file.

Per review of record, the center conducts emergency disaster drills every six months. Last drill conducted was in July 2022.

Director were 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.

Care providers are encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

As a result of today's inspection, a deficiency has been cited. See LIC809D for deficiency. Exit interview conducted and report was reviewed with Director. A copy of the report and appeal rights form were provided.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/06/2022 01:17 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 HABITAT CHILDREN'S CENTER	FACILITY NUMBER: 434413745
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the day care facility did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Per record review, six (6) staff's Mandated Reporter Training certifications have expired in 2021. This poses a potential risk to the Health, Safety or Personal Rights to children in care.
	POC Due Date: 10/06/2022
	Plan of Correction
1 2 3 4	Director stated staff will complete the Mandated Reporter Training for AB 1207 and submit proof of completion of training to CCL by POC due date of 10/06/2022.

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: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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