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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607404
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:20:02 PM

Document Has Been Signed on 02/08/2023 12:20 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: 30DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jose Chavez, Program Director TIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit.The LPA was greeted and screened by staff. At 11:15 a.m., the 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 11:30 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. ACTIVITY AREAS: The LPA observed the activity rooms/areas to be properly furnished. The LPA observed emergency water throughout the facility. At 11:02 a.m., the LPA observed the fire extinguishers to be fully charged and last serviced on 12/02/2022. 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 09/01/2022 with an expiration date of 07/31/2024. The LPA observed cameras installed in the hallways and common areas. At 11:32 a.m., the LPA observed clients participating in activities and watching movies. The LPA observed computers, exercise equipment and activities throughout the facility for client use. CLASSROOMS/OFFICES: The 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 11:36 a.m., hot water measured at 105.5-degree F. Client restrooms have two stalls for the men and three stalls for the women. KITCHEN: At 11:07 a.m., the LPA observed the kitchen. At 11:38 a.m., kitchen hot water measured at 105.8-degree F. OUTDOOR SPACE: At 11:39 a.m., the LPA observed the side patio. An outside gardening area is also available for clients. There is also a portable hand washing station for client use. 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. The LPA observed a 30-day supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. No deficiencies were observed at this time. Exit interview was conducted and report reviewed with the Program Director. A copy of the report was provided via email and print.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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