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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414100
Report Date: 07/25/2019
Date Signed: 07/25/2019 02:06:31 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 EXPLORERSFACILITY NUMBER:
434414100
ADMINISTRATOR:DARCY HELLUMS & ANN DOANFACILITY TYPE:
850
ADDRESS:604 E. EVELYN AVE.TELEPHONE:
(408) 685-2863
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:45CENSUS: 30DATE:
07/25/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ann DoanTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Ann Doan, co-director, for an unannounced case management inspection.

The Facility inquired with the Department about adding additional space (separate building located directly across the parking lot from the Facility) to the existing preschool license. LPA advised Ann that the separate building will require its own separate license since it has a different address than the existing Facility.

Ann states that she and Darcy Hellums (Licensee & co-director) are currently submitting documents to the city of Sunnyvale requesting approval to operate a separate preschool in the separate building located directly across the parking lot from the Facility. Ann states that she does not know how long that process will take and states that she will submit a new application packet for the separate preschool license once the city of Sunnyvale has granted approval.

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: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
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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