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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371674
Report Date: 05/21/2024
Date Signed: 05/21/2024 04:32:19 PM

Document Has Been Signed on 05/21/2024 04:32 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CREATIVE MINDS CHILDREN'S HOUSEFACILITY NUMBER:
304371674
ADMINISTRATOR/
DIRECTOR:		JAYASINGHE, INOKAFACILITY TYPE:
860
ADDRESS:23421 MADEROTELEPHONE:
(949) 619-5519
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 179TOTAL ENROLLED CHILDREN: 179CENSUS: 19DATE:
05/21/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Inoka Jayasinghe, ApplicantTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst, (LPA) P Rivas conducted an announced pre liensing inspection for a Change of Ownership. Upon arrival, LPA met with designated applicant Ms Inoka Jayasinge and facility Director Marie Roseline Sebaste "Rose".
Originally applicant requested capacity of 179 with 14 infants, 125 preschoolers and 40 school age. During visit applicant changed requested capacity as follows; 84 preschoolers (2years old to 5 years old) in classrooms(Rosewood Rm, Welcome Rm, Maple Room, Pine Rm). 14 Infants ages 6 wks to 2 year old in Infant Acorn Rm and Little Acorn Rm; 58 School Age children (ages from transitional Kindergarteners to 12 years old) in school age room and Cypress Room. Hours of operation will be; Preschool 7:30am to 6:00pm; Infant; 7:30am to 5:00pm; School age 2:45pm-6:00pm when school not in session 7:30am-6:00pm.
LPA observed 4 infants and 2 staff in Little Acorn Rm; 5 preschoolers in Pine Rm 2 staff; 10 preschoolers and 2 staff in Rosewood Room.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Ms. Inoka that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Ms Inoka stated that they will be kept in each room inaccessible to children in a higher cabinets. The school age medicine box will in a locked kitchen cabinet. In infant room medications will be kept in higher cabinet and refrigerator. A fully equipped first aid kit is located in each room. There is an operational carbon monoxide detector
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CREATIVE MINDS CHILDREN'S HOUSE
FACILITY NUMBER: 304371674
VISIT DATE: 05/21/2024
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on site located on wall in the welcome area (between Maple and Rosewood Rooms). All required licensing documents were observed posted in the
main lobby. Children will be signed in and out at in the lobby using individual QR codes but have paper sign ins if issues arise.
The facility has a main area that has rooms separated via bookshelves/furnishings into the Rosewood Room, Welcome Area and Maple Room. The Pine Room and Cypress room are also sectioned off using book cases and furnishings.

LPA continued to tour the facility and measured all indoor and outdoor activity space. Total indoor activity space measured at 5470.76 square feet which is insufficient for original capacity requested. During visit Ms. Inoka determined to reduce capacity request to 14 Infants, 84 preschoolers and 58 school-age. A new request to 156 was provided during visit. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots/mats, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms via individual water bottles or filtered water. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. A Fire clearance was granted on 03/14/24 for 179 children with original request of 14 infants, 40 school age and 125 preschool. A new requested will be submitted to Fire Department based on change of capacity.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CREATIVE MINDS CHILDREN'S HOUSE
FACILITY NUMBER: 304371674
VISIT DATE: 05/21/2024
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LPA observed a total of 13 toilets 1 urinal available for children’s use. However, two toilets in school age room were not counted as they do not offer individual privacy. LPA viewed 16 sinks available for children's use. The infant rooms each have a sink within hand's reach of changing table. These are sufficient to accommodate the requested capacity of 156 children. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the office and one bathroom and sink in the welcome area.

In infant rooms, high chairs and feeding tables have broad-based legs, plastic seats are in good repair and trays lock onto chairs. High chairs are made of washable, moisture-resistant material. Changing tables have at least 1” padding covered with moisture-resistant, washable material. Sides of the changing table are at least 3” high and the changing table is within arm’s reach of a sink. Diapering sink is not used for meal preparation or dishwashing. Cribs meet regulatory requirements. Crib area is separated from activity space via a wall. This barrier is at least four feet high, made of sound absorbing material and allows for supervision of napping children. Sleep logs are kept in infant room. Needs and Services Plans and Sleep Plans are kept in office. There are 10 cribs. Applicant will not admit more than 10 infants that require a crib or toilet. LPA observed 2 toilets in infant room(Acorn Room) and 3 sinks and 2 sinks little Acorn room.


LPA observed a total of 16 sinks available for children’s use.
Facility will provide breakfast and snacks. The kitchen area currently includes (stove, refrigerator, sinks, microwave, toaster, toaster oven, dishwasher). The kitchen area and food storage areas were observed free of rodents and/or vermin.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CREATIVE MINDS CHILDREN'S HOUSE
FACILITY NUMBER: 304371674
VISIT DATE: 05/21/2024
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Food was observed to be properly stored separate from cleaning materials. Hazardous items in kitchen are inaccessible to children via locked storage room.

The facility currently has three fully fenced playground areas. Fencing is brick and chain link fencing and is at least four feet high. The square footage the Infant yard is 2132 square feet, Preschool yard is 63,580.5 square feet, and School age yard is 6160 square feet, which is sufficient to accommodate the requested capacity of 156. Shade is provided via shade sails, awnings, umbrellas. There are sufficient outdoor age-appropriate toys and play equipment available on the playgrounds. There is are climbing structures on the playground for children Structures are properly anchored. There is adequate cushioning in fall zones of climber provided by pour and play cushioning material. Drinking water is available via water bottles. If children forget bottles facility will provide water bottles. Ms. Inoka was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). Water was tested on 01/20/23 with no Exceedances. Under current license.



The following corrections are needed prior to the issuance of the license:
1. Provide privacy in school age bathroom. There are two bathrooms with two toilets
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CREATIVE MINDS CHILDREN'S HOUSE
FACILITY NUMBER: 304371674
VISIT DATE: 05/21/2024
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in each bathroom but the toilets are situated side by side with no privacy. Per requested capacity of 58 school age children, four toilets are required. . Ms. Inoka will have plan to ensure privacy is provided. Plan to include but not limited to partitioning of the bathrooms.

2. In Pre school yard- loose bricks will be removed
3. In Pre school yard-where tree root was removed will be filled so ground is not uneven.
4. New approved fire clearance
5. Final review of documents.

Applicant/Licensee Representative Ms. Inoka Jayasinghe understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.
Applicant Ms. Inoka Jayasinghe was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.”
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CREATIVE MINDS CHILDREN'S HOUSE
FACILITY NUMBER: 304371674
VISIT DATE: 05/21/2024
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication:
Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. “
LPA reviewed with applicant Ms. Inoka the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.”

LPA discussed the safe sleep regulations with applicant, Ms. Inoka and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed Ms. Inoka of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Ms. Inoka, applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CREATIVE MINDS CHILDREN'S HOUSE
FACILITY NUMBER: 304371674
VISIT DATE: 05/21/2024
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A notice of site visit was given to Ms. Inoka Jayasinghe facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
Exit interview conducted and report was reviewed with the Ms. Inoka ,applicant,. Please include their name.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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