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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607404
Report Date: 04/30/2024
Date Signed: 04/30/2024 07:18:52 PM

Document Has Been Signed on 04/30/2024 07:18 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CREATIVE MINDS ADP, INC.FACILITY NUMBER:
197607404
ADMINISTRATOR/
DIRECTOR:		JOSE CHAVEZFACILITY TYPE:
775
ADDRESS:6045 WOODMAN STREETTELEPHONE:
(818) 780-1641
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY: 105CENSUS: 82DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:26 AM
MET WITH:Jose ChavezTIME VISIT/
INSPECTION COMPLETED:
02:27 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff. The LPA met with the Program Director (PD), Jose Chavez and explained the reason for the visit.

At 10:30 a.m., the LPA, and the PD 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.
During the tour, the LPA observed offices, classrooms, kitchen areas, restrooms, and an outdoor area. The facility does not handle medications, therefore there are no provisions for a locked storage space. Clients keep personal belongings in individual lockers. There is a sufficient supply of drinking water. An activity calendar along with other documents are posted as mandated. All trash cans were observed to have tight fitting lids. Disaster drills are conducted every month and documented in the Drill Log Sheet. The program operates Monday to Friday, from 9:00 a.m. to 3:00 p.m.

ACTIVITY/COMMON AREAS: The LPA observed the activity rooms and classrooms to be properly furnished. Emergency food and water was observed in the main room and in the adjacent kitchen. The LPA observed the fire extinguishers to be fully charged and last serviced on 04/22/2024. Required postings are posted throughout facility. Fire alarm/sprinkler system was observed and was last tested on 02/27/2024 by the Los Angeles City Fire Department (LAFD). LPA observed cameras installed in the hallways and common areas. Inside temperature was maintained at a comfortable level between 73 and 74 degrees.

KITCHEN: Kitchen cabinets were inspected for toxic/cleaning solutions and sharp objects; none were observed to be stored in the kitchen area. A large first aid kit is located in the kitchen. Toxins, and sharp objects are locked and located in the program supervisor's office.
Continues on LIC 809C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CREATIVE MINDS ADP, INC.
FACILITY NUMBER: 197607404
VISIT DATE: 04/30/2024
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RESTROOMS: Restrooms are clean, sanitary and in operating condition. The hot water measured at 110.8 degrees 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.
OUTDOOR SPACE: The side patio has a covered outdoor area for client use. Passageways were free and clear from obstruction. An outside gardening area is available for clients.
RECORDS: Records review began at 12:04 p.m. Clients’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms, written needs and services appraisals, and personal rights forms. All records were in order. Personnel records were reviewed for, but not limited to health screenings, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient.

The LPA reviewed the following documents:


- LIC500 Personnel Report
- LIC9020 Client Roster
- Liability Insurance

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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