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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515404615
Report Date: 01/17/2024
Date Signed: 01/18/2024 12:10:16 PM


Document Has Been Signed on 01/18/2024 12:10 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:CREATIVE KIDS PRESCHOOL & DAYCAREFACILITY NUMBER:
515404615
ADMINISTRATOR:SHIDELER, DONNAFACILITY TYPE:
850
ADDRESS:1060 LINCOLN ROAD, SUITE FTELEPHONE:
(530) 751-9217
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:35CENSUS: 24DATE:
01/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Michelle LightleTIME COMPLETED:
03:15 PM
NARRATIVE
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On January 17, 2024, at 11:30am, Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection and met with Licensee Michelle Lightle. A review of the facility's Guardian Roster Report dated 1/16/2024 indicates criminal record clearances were not obtained for Staff #1 and Staff #2 prior to allowing them to work at the facility.

The following deficiency was cited: 101170(e)(1) Criminal Record Clearance. See LIC 809D.

LPA Laura Chavez informed licensee Michelle Lightle that this report dated 1/17/2024 documents one Type A citation 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.


Also, LPA Laura Chavez informed Licensee Michelle Lightle to provide a copy of this licensing report dated 1/17/2024 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.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CREATIVE KIDS PRESCHOOL & DAYCARE
FACILITY NUMBER: 515404615
VISIT DATE: 01/17/2024
NARRATIVE
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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/Director Michelle Lightle.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 01/18/2024 12:10 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: CREATIVE KIDS PRESCHOOL & DAYCARE
FACILITY NUMBER: 515404615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/18/2024
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to H&S Code Section 1596.871 shall prior to working, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.
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The licensee agrees to not allow Staff #1 and Staff #2 to work at or volunteer at the facility until clearances have been obtained as required by the Department.

Civil Penalty assessed.
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This requirement is not met as evidenced by: The licensee failed to obtain a Criminal Record Clearance for Staff #1 and Staff #2 prior to prior to allowing them to work at the facility.
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The licensee agrees to provide proof of
Staff #1 and Staff #2 being livescanned.

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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: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024
LIC809 (FAS) - (06/04)
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