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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607404
Report Date: 04/21/2022
Date Signed: 04/21/2022 12:32:22 PM

Document Has Been Signed on 04/21/2022 12:32 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CREATIVE MINDS ADP, INC.FACILITY NUMBER:
197607404
ADMINISTRATOR:JOSE CHAVEZFACILITY TYPE:
775
ADDRESS:6045 WOODMAN STREETTELEPHONE:
(818) 780-1641
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY: 105CENSUS: 0DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Jose Chavez, Program Director TIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by staff. At 10:07 a.m., LPA met with the Program Director, Jose Chavez and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures.

At 10:58 a.m., the LPA, along with the Program Director toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.
The day program currently does not have clients inside the facility but are operating through community outings and alternative services.

ACTIVITY AREAS: The LPA observed the activity room/areas to be properly furnished. LPA observed emergency water throughout the facility. At 11:02 a.m., LPA observed the fire extinguisher to be fully charged and last serviced on 06/25/2021. Signs are posted throughout facility to promote hand-washing, cough/sneeze etiquette, and physical distancing. Fire alarm/sprinkler system was observed and was last tested on 10/30/2021 with an expiration date of 12/31/2022. LPA observed cameras installed in the hallways and common areas.

CLASSROOMS/OFFICES: LPA observed offices and classrooms, which were observed to have the required furniture and supplies. Inside temperature was maintained at a comfortable level.

RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition. At 11:06 a.m., hot water measured at 105.2-degree Fahrenheit. Signs are posted throughout all four (4) restrooms to promote hand-washing. Client restrooms have two stalls for the men and three stalls for the women. All trash cans observed had tight fitting lids. Continued on LIC 809-C.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CREATIVE MINDS ADP, INC.
FACILITY NUMBER: 197607404
VISIT DATE: 04/21/2022
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KITCHEN: At 11:07 a.m., the LPA observed the kitchen. Cleaning solutions, toxins, chemicals and other hazardous items were inaccessible and locked away in the kitchen.

OUTDOOR SPACE: At 11:08 a.m., LPA observed the side patio. The side patio has covered outdoor area for client use. There is also a portable hand washing station for client use. Passageways were free and clear from obstruction.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Program Director regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient.

At 11:17 a.m., LPA conducted Infection Control mitigation module with Program Director.

Exit interview was conducted and report reviewed with the Program Director. A copy of the report was provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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