434417011-10-6-2021-07-CC-MSMS-C7JRQ5-20211006131257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417011
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:13:08 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 EXPLORERS INC.		FACILITY NUMBER:	434417011
ADMINISTRATOR:	ANN DOAN		FACILITY TYPE:	850
ADDRESS:	610 EAST EVELYN AVENUE		TELEPHONE:	(408) 685-2110
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	24	CENSUS: 0	DATE:	10/06/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Darcy Hellums & Ann Doan		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 Analysts (LPAs) Mel Matos and Cortney Nelson, conducted an announced prelicensing inspection at the Facility. LPAs met with Darcy Hellums, Applicant Representative, and Ann Doan, Director, and explained the nature of today's inspection to them. The Applicant has applied for a license for 24 preschool children and a fire inspection approval from the Sunnyvale Department of Public Safety for 24 preschool children was received on August 31, 2021. The Preschool Center will operate Monday through Friday from 7 AM to 7 PM, serving Preschool children ages 2 years to entry into first grade. The Preschool program will be utilizing one Classroom and outdoor playground area. LPAs toured and measured the indoor and outdoor areas of the Facility with Ann Doan, director, during today's inspection. INDOOR MEASUREMENTS ARE AS FOLLOWS: Classroom: 1) 12.583 x 22.583 = 284.161 minus (13.000 x 4.000 = 52.000) encumbered space = 232.161 2) 28.083 x 31.083 = 872.903 minus ((4.000 x 1.250) x 3.000 = 15.000) encumbered space = 857.903 Preschool Indoor Space Total = 1,090.064 sq. ft. divided 35 sq. ft. = 31 preschool children. There are 2 sinks (30) and 2 toilets (30) available for the preschool children in the children's bathroom. There is hot water (less than 120 degrees F) available in the children's sinks. LPAs observed soap dispensers and disposable towels in the children's bathroom. There is one separate bathroom, located near the kitchen area of the Facility, that will be utilized by sick children if necessary. Sick children will be isolated in the Staff Room and isolation equipment is provided. Potty training will be provided by the Facility. The Facility will utilize the 3 step method of soap/bleach/water for disinfecting purposes.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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 EXPLORERS INC.	FACILITY NUMBER: 434417011
	VISIT DATE: 10/06/2021

NARRATIVE

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LPAs observed no fireplaces or wall heater units in the Facility. The Classroom has appropriate lighting, heating, and air conditioning. First aid kit (including touchless thermometer) is stored in the Facility inaccessible to the children. Medications will be stored in the staff room inaccessible to children. The Director has the full 15 hours of Health and Safety Training. The Facility has working smoke/carbon monoxide detectors and centralized fire alarm system.

This Facility plans to provide Incidental Medical Services – IMS. A Plan of Operation that includes IMS has been submitted to the Department. Information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

There are 4 tables, 26 chairs, 24 cubbies, and 40 cots available for the preschool children. There is adequate equipment, supplies and toys for the children in the Facility. Drinking water will be provided indoors via pitchers/water bottles/disposable cups. There is a working telephone at the site. The phone number is (408) 685-2110. Ann states that there are no weapons on the premises.

The food preparation area (kitchen) is functional and has hot and cold running water, sink, refrigerator, toaster oven, and storage space for food supplies. The Facility will only provide breakfast and snacks to the children. The children will be required to provide their own lunches. Cleaning and sanitation of dishes and utensils will be done via hand washing. Disposable utensils and plates will be utilized by the Facility. LPAs observed solid waste containers with tight-fitting lids in the Facility. Cleaning supplies are stored on high shelves in the off limits kitchen area inaccessible to children.

Darcy Hellums, Applicant Representative, Ann Doan, Director, and two staff have obtained the Criminal Record and Child Abuse Index clearances. Darcy and Ann has met the education and experience qualification requirements and current Pediatric First Aid/CPR Certifications are on file. Proof of completion of Preventative Health Practices and vaccination records for Mmr, Tdap, and Influenza are on file for Ann and Darcy

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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 EXPLORERS INC.	FACILITY NUMBER: 434417011
	VISIT DATE: 10/06/2021

NARRATIVE

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LPAs reminded Ann of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

OUTDOOR MEASUREMENTS ARE AS FOLLOWS:

PRESCHOOL PLAYGROUND:

1) 15.583 x 5.833 = 90.895
2) 37.333 x 22.583 = 843.091
3) 5.000 x 5.167 = 25.835
4) 9.167 x 10.000 = 91.670

TOTAL OUTDOOR SPACE: 1,051.491 sq. ft. divided by 75 = 14 preschool children.

LPAs observed that the preschool playground is surrounded by appropriate fencing. The playground equipment is age appropriate and artificial grass with rubber padding is used as resilient materials. Shade is provided by the building overhang and umbrellas. Drinking water will be provided via pitchers/water bottles/disposable cups. There is adequate age appropriate supplies and toys for children in the playground. LPAs did not observe any bodies of water during today's inspection. Transportation will not be provided by the Facility.
A playground waiver request, along with a copy of the daily schedule was provided to LPAs during today's inspection.
LPAs discussed "zero tolerance" related regulations with Ann and advised her of the assessment of an immediate $150 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $150 per day continues until the violation(s) is corrected.

LPAs conducted an exit Interview and advised Ann that a license for 24 preschool children will be approved upon completion of the following items:
1) Playground waiver request has been reviewed and approved by LPA Matos' manager

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC809 (FAS) - (06/04)

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