434414100-8-15-2024-07-CC-BDEL-DAGTNN-20241028145301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414100
Report Date: 08/15/2024
Date Signed: 08/15/2024 12:56:05 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
08/08/2024 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20240808085020

FACILITY NAME:	CREATIVE EXPLORERS		FACILITY NUMBER:	434414100
ADMINISTRATOR:	DARCY HELLUMS		FACILITY TYPE:	850
ADDRESS:	604 E. EVELYN AVE.		TELEPHONE:	(408) 685-2863
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	45	CENSUS: 26	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Darcy Hellums		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility did not report an epidemic outbreak to the Department

Facility did not report an epidemic outbreak to the local health officer

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mel Matos met with Darcy Hellums, Licensee/Director, for an unannounced 10 day complaint investigation. LPA discussed the allegations listed above with Darcy during today's investigation.

Darcy states that the Facility had four staff (teachers) test positive for COVID between July 26, 2024 and August 7, 2024. Darcy states that four staff (teachers) contracted COVID between July 26, 2024 and August 7, 2024. Darcy states that three staff returned to work after staying home for three days after testing positive. Darcy states that the three staff also had no symptoms and were fever free for at least 24 hours prior to returning to work. Darcy states that staff wore masks for 10 days upon returning to work as a precaution.

Darcy states that she did not notify the Department and the local health officer of the four COVID cases involving staff. Darcy states that she was not aware that she needed to contact the Department and the local health officer to report the COVID cases.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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-20240808085020

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE EXPLORERS	FACILITY NUMBER: 434414100
	VISIT DATE: 08/15/2024

NARRATIVE

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Based on interviews and evidence gathered during the investigation process, the Department concludes that 1) Facility did not report an epidemic outbreak to the Department and 2) Facility did not report an epidemic outbreak to the local health officer. The allegations noted above are thus found to be SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard has been met.

Two "Type B" deficiencies are being cited on the attached LIC 9099-D as a result of the Substantiated complaint investigation. Copy of Department regulations - Section 101212 - Reporting Requirements - of Title 22 was provided to Licensee/Director, Darcy Hellums.

Exit interview conducted and report was reviewed with the Licensee/Director, Darcy Hellums. Appeal rights was also provided to the Licensee/Director, Darcy Hellums, prior to conclusion of today's investigation.

Notice of site visit was issued and posted by Director prior to the conclusion of today's investigation. LPA reminded Licensee/Director, Darcy Hellums, that the notice of site visit must remain posted for 30 days

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20240808085020

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE EXPLORERS	FACILITY NUMBER: 434414100
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2024 Section Cited CCR 101212(d)(1)(E)	1 2 3 4 5 6 7	Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.	1 2 3 4 5 6 7	Darcy Hellums, Licensee/Director, agreed to submit a written Plan of Correction indicating what steps the Facility will implement to ensure that the Facility will report all epidemic outbreaks to the Dept within the required time frames as noted in the Department's reporting requirements.
	8 9 10 11 12 13 14	Events reported shall include the following: Epidemic outbreaks. This requirement was not met as evidenced by: Facility had four staff (teachers) test positive for COVID between July 26, 2024 and August 7, 2024 & the Facility did not report the epidemic outbreak to the Dept. This presents a potential risk to the health, safety, or personal rights of children in care.	8 9 10 11 12 13 14
Type B 08/23/2024 Section Cited CCR 101212(g)	1 2 3 4 5 6 7	Reporting Requirements: The items specified in (d)(1)(E) through (G) above shall also be reported to the local health officer when appropriate pursuant to Title 17, California Code of Regulations, Title 17, Section 2500. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Darcy Hellums, Licensee/Director, agreed to submit a written Plan of Correction indicating what steps the Facility will implement to ensure that the Facility will report all epidemic outbreaks to the local health officer within the required time frames as noted in the Department's reporting requirements.
	8 9 10 11 12 13 14	Facility had four staff (teachers) test positive for COVID between July 26, 2024 and August 7, 2024 & the Facility did not report the epidemic outbreak to the local health officer. This presents a potential risk to the health, safety, or personal rights of children in care.	8 9 10 11 12 13 14

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: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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