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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607404
Report Date: 04/02/2025
Date Signed: 04/02/2025 03:14:34 PM

Document Has Been Signed on 04/02/2025 03:14 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: 85DATE:
04/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Jose ChavezTIME VISIT/
INSPECTION COMPLETED:
03:17 PM
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Licensing Program Analyst (LPA) Erica Mosley arrived at the Adult Day Program (ADP) unannounced to conduct a required annual visit at 9:45 a.m. The LPA met with Director, Jose Chavez and explained the reason for the visit. Upon arrival, there were sixty (60) consumers and twenty-one (21) staff in the building. The program currently operates from 9:00 a.m. to 3:00 p.m. The day program is staffed with a 1:6 staff to consumer ratios.

At 10:05 a.m., the LPA and the Director toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Fire alarm/sprinkler system was observed and was last tested on 09/26/2024 by the Los Angeles City Fire Department (LAFD). LPA observed cameras installed in the hallways and common areas. The LPA observed fire extinguishers throughout the facility, which were last serviced on 4/22/2024 and 04/02/2025. The last emergency disaster drill took place on 03/26/2025 and are conducted quarterly. The facility utilizes an emergency preparedness lesson plan that is conducted regularly with consumers to educate them on emergency preparedness. Consumers keep personal belongings in individual lockers. There is a sufficient supply of drinking water, emergency water and emergency food. Cleaning supplies are stored in a locked closet adjacent to the computer room. Sharps and knives are stored in a locked Supervisor's office. The facility maintained a comfortable temperature. The LPA observed required postings throughout the facility. Entry/exits were free of obstruction. The facility does not handle medications, therefore there are no provisions for a locked storage space.

(PAGE 1) ...Report will continue on LIC809-C PAGE 2...
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 4
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: 04/02/2025
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(PAGE 2) (Report Continued from LIC 809 PAGE 1...)

Common Activity Space: The facility is a single-story structure with an open floor plan including a main activity area, food storage area with two (2) refrigerators for consumer lunch storage, food pantry room with multiple refrigerators and shelves for food bank food storage, computer room, locked offices, a multi functional gym area with cardiovascular machines, kitchen area, bathrooms and an outdoor area. The LPA did not observe any obstructions or hazards during the inspection. The program site appeared to be clean, sanitary, and in good repair at the time of the visit. Activities observed during the visit.

Outdoor Space: The side patio has a covered outdoor area including a table and chairs for consumer use. Passageways were free and clear of obstruction. An outdoor gardening area is available for consumers.


Food Service: The kitchen area was clean and in good condition. Consumers bring their lunch and snacks. The facility has emergency water, food supplies and snacks available for consumers.

Restrooms: Restrooms were clean, sanitary and in operating condition. There are four (4) total restrooms of which two (2) are primarily used for consumer use with three (3) stalls for women and two (2) stalls for men. Restrooms were observed to be equipped with hand soap and paper towels. Signs are posted throughout all four (4) restrooms to promote hand washing. The hot water temperature in the restrooms was tested at 10:22 am and measured at 106.7 degrees Fahrenheit within the required range.

Record Review: At 10:30 a.m. a review of facility files was initiated. Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate.

Personnel Records were reviewed beginning at 10:36 a.m. Nine (9) Personnel files including the Directors file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order.

Consumer Records were reviewed beginning at 11:15 a.m. Eight (8) Consumer files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order.

(PAGE 2) ...Report will continue on LIC809-C PAGE 3...

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 04/02/2025
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(PAGE 3) (Report Continued from LIC 809 PAGE 2...)

Vehicle inspection: Daily vehicle inspection log was reviewed for facility vehicles. All records were in order.



Interview: During today's visit, starting at 2:25 p.m. the LPA interviewed eight (8) staff and eight (8) consumers. Interviews revealed that staff are knowledgeable in consumer rights, different forms of abuse and reporting procedures. Consumer interviews revealed that no concerns were noted or voiced at the time of the visit.

LPA obtained the following documents - Consumer roster, Staff roster- LIC 500, and copy of the Limited Liability insurance.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4