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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614527
Report Date: 09/07/2023
Date Signed: 09/07/2023 01:48:36 PM

Document Has Been Signed on 09/07/2023 01:48 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KREATIVE KIDS LEARNING CENTERFACILITY NUMBER:
343614527
ADMINISTRATOR:MILLS, BRIGINIAFACILITY TYPE:
850
ADDRESS:7020 WYNDHAM DR.TELEPHONE:
(916) 689-3777
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 57TOTAL ENROLLED CHILDREN: 57CENSUS: 32DATE:
09/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth Donkor & Briginia MillsTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gagandeep Singh met with the facility representative, Elizabeth Donkor and Briginia Mills. During the investigation of a complaint, it was found that there an incident of two children leaving the facility, but the facility did not report to the Department. LPA reminded the facility the requirement of reporting any unusual incidents to the Department. Because the facility failed to report the incident, see next page for citation given today. Copy of this report was reviewed and provided to the facility representative. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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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Document Has Been Signed on 09/07/2023 01:48 PM - It Cannot Be Edited


Created By: Gagandeep Singh On 09/07/2023 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KREATIVE KIDS LEARNING CENTER
FACILITY NUMBER: 343614527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
101212(d)(1)(C)

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced that the facility did not reported an incident of two children’s absence to the Department. This poses a potential Health and Safety risk to children in care.
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Director agreed to follow the requirement of reporting the Department within 24 hours via telephone and written report within seven days.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023


LIC809 (FAS) - (06/04)
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