<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191800179
Report Date: 08/11/2022
Date Signed: 08/11/2022 04:52:58 PM

Document Has Been Signed on 08/11/2022 04:52 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CREATIVE LEARNING ACADEMY, INC.FACILITY NUMBER:
191800179
ADMINISTRATOR:CYNTHIA SANDERSFACILITY TYPE:
850
ADDRESS:1718,16&14 W.MARTIN L. KING BLTELEPHONE:
(323) 294-1444
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY: 96TOTAL ENROLLED CHILDREN: 80CENSUS: 44DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Cynthia Sanders, DirectorTIME COMPLETED:
05:00 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 Analyst (LPA) Alicia Mooberry conducted an Required Annual Inspection. LPA met with Site Director Cynthia Sanders who provided a tour of the facility. There were 26 children supervised by 4 staff on the playground and 18 student supervised by 4 staff in the preschool classroom. The staff supervising is qualified and has obtained background clearance. Per director, the hours of operation are Monday-Friday 6:30am-6pm.

LPA observed required posted documentation located in the classroom, which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System and LIC 613A- Notification of Parent’s Rights. LPA observed a current menu.

LPA toured Classrooms and observed that furniture and equipment is maintained in good condition, free of loose, sharp and/or pointed parts. The floors of the classrooms has surfaces that are safe and clean. Drinking water is made readily available for the children via water dispenser both indoor and outdoors in the playground.

Cleaning products are stored in the storage unit located on the playground.

LPA observed required Carbon Monoxide detector that is operable. Facility has smoke detectors and fire extinguishers that are routinely serviced by the fire department.

Per Director, there are no children currently on medication.

LPA toured the children’s restroom. Restroom was observed to be sanitary and free of hazards.

The napping equipment was clean, each child has napping items in appropriate individual storage for children's belongings. An isolation area with a sink, toilet, and mats/cots is located in the preschool room.

---------Page 1

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CREATIVE LEARNING ACADEMY, INC.
FACILITY NUMBER: 191800179
VISIT DATE: 08/11/2022
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
26
27
28
29
30
31
32
LPA toured the outdoor play area. The outdoor space is free of hazards. There is cushioned material throughout in good condition. Outdoor space has various areas of shade for children to play. Water is readily available to children via water dispenser. There are no pools, spas, or other bodies of water on school grounds. There are no firearms or weapons stored at the facility.
Per Director the school has water activities planned using, which are supervised at all times. LPA reminded director to ensure the pool is low enough for children to step out unassisted and to empty pool after every use.

LPA reviewed Sign In/Out sheets located at the front entrance of the school. LPA observed that 20 out of the 44 children present were not signed in, this poses a potential risk to the health and safety of children in care. Per Director, the facility uses an electronic sign in as well as paper. LPA reminded Director to ensure the children present are signed in and out with date, time and full signature of guardian and the record is kept for 30 days and available to licensing.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on July 2022 .

Children’s records were reviewed at 12:00 PM for Emergency Card, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All children's records were complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 503- Health Screening, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts or Permit and current Mandated Reporter Training Certificate. LPA observed that 8 out of 8 staff records reviewed did not have proof of immunization for Measles, Pertussis and Influenza. Three (3) out of eight (8) files reviewed did not have TB clearance on file, this poses a potential risk to the health and safety of children in care.

LPA toured the kitchen. All kitchen areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on, and in good repair.

------------------------PAGE 2

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CREATIVE LEARNING ACADEMY, INC.
FACILITY NUMBER: 191800179
VISIT DATE: 08/11/2022
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
26
27
28
29
30
31
32
Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA observed that facility is implementing COVID-19 precautions and procedures. For the latest guidance on COVID-19 visit LA Department of Public Health.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department. The following 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Facility Representative, Cynthia Sanders

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/11/2022 04:52 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 08/11/2022 at 03:45 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CREATIVE LEARNING ACADEMY, INC.
FACILITY NUMBER: 191800179

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 8 out of 8 staff did not have proof of immunization for Measles, Pertussis and Influenza. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2022
Plan of Correction
1
2
3
4
Per Director, proof of immunization for Staff #1-#8 will be sent to LPA vial email by POC due date.
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in Three (3) out of eight (8) files reviewed did not have TB clearance on file which posesa potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2022
Plan of Correction
1
2
3
4
Per Director, proof of TB clearance for Staff #6-#8 will be sent to LPA via email by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/11/2022 04:52 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 08/11/2022 at 03:45 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CREATIVE LEARNING ACADEMY, INC.
FACILITY NUMBER: 191800179

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(d)
Sign In and Sign Out
(d) The sign-in and sign-out sheets with the signatures required by this section and by Section 101226.1 shall be kept for one month and shall be available at the center for review by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in 20 out of 44 children present were not signed on the sign in sheet which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/19/2022
Plan of Correction
1
2
3
4
Per director, they will send a memo parent reminding the to sign their children in daily. A copy of the memo will be provided to LPA by email by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022


LIC809 (FAS) - (06/04)
Page: 5 of 5