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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515402561
Report Date: 04/23/2024
Date Signed: 04/23/2024 05:39:28 PM


Document Has Been Signed on 04/23/2024 05:39 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:CREATIVE KIDS - INFANTFACILITY NUMBER:
515402561
ADMINISTRATOR:WESTMORELAND, AMANDAFACILITY TYPE:
830
ADDRESS:883 SOUTH WALTON AVENUETELEPHONE:
(530) 751-0678
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:8CENSUS: 8DATE:
04/23/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:13 PM
MET WITH:Michelle LightleTIME COMPLETED:
05:48 PM
NARRATIVE
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On April 23, 2024, at 5:13pm, Licensing Program Analyst (LPA) Sydney Sims and Tammy Dutra conducted a case management inspection and met with Licensee Michelle Lightle. During Record review LPAs observed that infant Teacher (S1) was removed from the facility roster in 2019. Licensee confirmed that (S1) returned to the facility and started working in 2020 and did not obtain fingerprint clearance.

The following deficiency was cited: HSC 1596.871(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

LPA Tammy Dutra and Sydney Sims informed licensee Michelle Lightle that this report dated 4/23/24 documents One Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 04/23/2024 05:39 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: CREATIVE KIDS - INFANT
FACILITY NUMBER: 515402561

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/24/2024
Section Cited
HSC
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, ... prior to employment, residence, or initial presence in the facility.
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Licensee will write statement stating that Licensee will not allow S1 to return to facility until S1 has obtained criminal record clearance. Licensee will provide statement to LPA Sims by 4/24/24.
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This requirment was not met as evidence by:
Based on record review S1 was removed from the gaurdian roster in 2019 and return to work at the facility in 2020 and did not obtain a criminal record clearance.
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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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CREATIVE KIDS - INFANT
FACILITY NUMBER: 515402561
VISIT DATE: 04/23/2024
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Also, LPA Tammy Dutra and Sydney Sims informed the licensee to provide a copy of this licensing report dated 4/23/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal Rights and a Notice of Site Visit were given. The Notice of Site Visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. All licensing reports are public information and must be made available upon request for at least three years.



An exit interview was conducted, and the report was reviewed with Licensee Michelle Lightle.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3