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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419522
Report Date: 12/15/2021
Date Signed: 12/15/2021 12:33:43 PM

Document Has Been Signed on 12/15/2021 12:33 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CREATIVE HANDS LEARNING ACADEMYFACILITY NUMBER:
197419522
ADMINISTRATOR:MADISON, NATASHA LORENEFACILITY TYPE:
850
ADDRESS:2320 W. MARTIN LUTHER KINGTELEPHONE:
(310) 462-6097
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY: 63TOTAL ENROLLED CHILDREN: 63CENSUS: 36DATE:
12/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Natasha MadisonTIME COMPLETED:
12:45 PM
NARRATIVE
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On 12/14/2021 Licensing Program Analyst, Stella Gutierrez conducted a unannounced visit to the facility. LPA was met by Natasha Mdison, Administrator and was explained the purpose of the visit. LPA observed 36 children present and 6 adults providing supervision and care. All adults present today have a criminal record clearance and are associated to the facility roster.

It was revealed during the course of an investigation that the facility did not abide by regulation 101212 Reporting Requirements standards. It was know that an incident occurred on 11/19/2021 and was reported to Community Care Licensing Division- Child Care Program on 11/23/2021 by another party other than the facility representative.

Type A deficiency will be cited during today's inspection. A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next operating day.

Exit interview conducted, A copy of this report and notice of site visit was provided to Natahsa Madison, Administrator.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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Document Has Been Signed on 12/15/2021 12:33 PM - It Cannot Be Edited


Created By: Stella Gutierrez On 12/13/2021 at 10:42 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CREATIVE HANDS LEARNING ACADEMY
FACILITY NUMBER: 197419522

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2021
Section Cited
CCR
101212(d)(1)(B)

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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours...

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Type A deficiency cleared today by a written declaration from Administrator stating that she understands the regulation mentioned and will maintain compliance of reporting requirements in accordance to title 22. A copy of the regulation was provided to Administrator during today's inspection.
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Based on LPA's interviews and information received this standard was not met by evidence of Administrator admitting that an injury incident occurred at the facility on 11/19/2021 and was not reported to the El Segundo Regional office.
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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:Karren Starks
LICENSING EVALUATOR NAME:Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021


LIC809 (FAS) - (06/04)
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