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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011400147
Report Date: 09/12/2023
Date Signed: 09/12/2023 01:07:59 PM

Document Has Been Signed on 09/12/2023 01:07 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CREATIVE GROWTHFACILITY NUMBER:
011400147
ADMINISTRATOR:DIMARIA, THOMASFACILITY TYPE:
775
ADDRESS:355 - 24TH STREETTELEPHONE:
(510) 836-2340
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY: 90CENSUS: 50DATE:
09/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Thomas di Maria, AdministratorTIME COMPLETED:
01:15 PM
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On 9/12/23 at 10:30 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Thomas di Maria, Administrator and explained the purpose of the visit. Day program operates from 9:30 a.m. to 3:30 p.m. There were 12 staff observed working with the 50 clients here today.

LPA toured facility including but not limited to, activity room, kitchen area and bathrooms. Clients bring their own lunches and snacks. Emergency supplies, including water were observed. The hot water temperature in the men's bathroom sink measured 107.3 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition. Incontinent clients are kept clean and dry, and the facility is free of odors.

At 11:00 a.m., LPA reviewed 5 client records. At 11:45 a.m., LPA reviewed 5 staff files and 5 of 5 have fingerprint clearance and are associated to the facility. Fire extinguisher was last serviced on 8/10/23. First aid kit was checked and found to be complete.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/19/23:

LIC 500 Personnel Report
LIC 308 Designation of Administrative Responsibility
LIC 610 Emergency Disaster Plan

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2023
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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