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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700527
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:46:08 PM

Document Has Been Signed on 06/12/2024 03:46 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 1102
OAKLAND, CA 94612
FACILITY NAME:CREATIVE WORLDFACILITY NUMBER:
015700527
ADMINISTRATOR/
DIRECTOR:		BRUMFIELD, AZIZAFACILITY TYPE:
850
ADDRESS:14830 WASHINGTON AVENUETELEPHONE:
(510) 567-3733
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 26DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:49 AM
MET WITH:Essie DayTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 6/12/2024 at 8:49am Licensing Program Analysts (LPAs) Morgan Pringle and Christina Uribe conducted an Unannounced Case Management Visit. LPA Michael Mathew was present conducting a separate complaint visit as well. LPAs rang the doorbell and called the facility upon arrival. LPAs were met at the front door by facility staff. LPAs entered the facility, introduced themselves, and stated the nature of the visits. Present during LPAs walk through of the facility were three (3) staff members, two (2) minor aides, nine (9) toddlers and seventeen (17) preschool age children.

Physical evidence was previously obtained that showed that a flood had occurred inside of the facility on 2/22/2024 around 12:18pm. Evidence shows standing water in the facility and statements obtained provided details that the water causing the flood was sewage water. Evidence obtained showed that children were present and were exposed to unsanitary standing water inside of the facility while in care. This presented an immediate risk to the health and safety of the children in care.

Facility will also be cited a type B deficiency for not reporting the unusual incident of the flooding that happened on 2/22/2024 to the Oakland South East Regional office of Community Care Licensing.

Around 9:00am LPAs observed one (1) aide and one (1) minor aide supervising nine (9) toddlers without the supervision of a fully qualified teacher in the toddler room located in the back of the facility making the classroom out of ratio. Facility staff and owner stated that there was a misunderstanding in what classes facility staff should have taken. LPAs informed staff of the correct courses that will fulfill the requirements. The facility was previously cited a Type B deficiency for ratio on 1/24/2024 and 4/8/2024. Due to this a Type A citation will be cited during this visit.

LPAs Morgan Pringle and Christina Uribe informed Facility Owner Essie Day that this report dated 6/12/2024 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527
VISIT DATE: 06/12/2024
NARRATIVE
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Also, LPAs Morgan Pringle and Christina Uribe informed the facility owner to provide a copy of this licensing report dated 6/12/2024 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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility owner Essie Day and facility staff Maria Livingstone.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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Document Has Been Signed on 06/12/2024 03:46 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Morgan Pringle On 06/12/2024 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
06/13/2024
Section Cited
HSC
1596.955(a)(3)

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1596.955(a)(3) A ratio of six children to each teacher is maintained for all children in attendance at the toddler program. An aide who is participating in on-the-job training may be substituted for a teacher when directly supervised by a fully qualified teacher.
This requirement was not met as
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By the POC date listed, facility owner must send LPA Pringle a plan stating how the facility will meet the ratio requirements moving forward for adequate staffing.
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evidenced by: LPAs observed two (2) aides supervising nine (9) toddlers without the direct supervision of a fully qualified teacher. Facility was previously cited twice for the same citation. This now poses an immediate risk to the health and safety of the children in care.
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Under Appeal
Type A
06/13/2024
Section Cited
CCR101223(a)

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101223(a)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Owner must produce a receipt of plumbing company that was used for the flooding that occurred on 2/22/2024 that shows proper water removal and sanitization of the facility by end of facility business day Thursday, 6/13/2024.
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This requirement was not met as evidenced by: evidence was obtained showing children were present during a flood where children were exposed to unsanitary standing water inside of the facility. This provides an immediate risk to the health and safety of the children in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


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Document Has Been Signed on 06/12/2024 03:46 PM - It Cannot Be Edited


Created By: Morgan Pringle On 06/12/2024 at 01:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CREATIVE WORLD
FACILITY NUMBER: 015700527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2024
Section Cited
CCR
101212(a)

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101212(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following...: This requirement was not met as evidenced by:
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Facility Staff or Owner will submit an Unusual Incident Report to the Department by the POC listed above.
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Facility staff did not send the Department an Unusual Incident report for the flooding that occured on 2/22/2024. This poses a potential risk to the health and safety and/or personal rights to the children in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


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