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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623141
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:11:33 PM


Document Has Been Signed on 03/28/2023 04:11 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:CREATIVE SPIRIT LEARNING CENTERFACILITY NUMBER:
343623141
ADMINISTRATOR:BRANN, NICOLEFACILITY TYPE:
850
ADDRESS:10729 FAIR OAKS BLVDTELEPHONE:
(916) 967-7883
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:24CENSUS: 19DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Aruna SankariTIME COMPLETED:
04:30 PM
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On Tuesday, March 28, 2023 Licensing Program Analyst (LPA) Lea Habtom met with lead teacher Aruna Sankari for the purpose of an unannounced 1 year required inspection. Lead teacher Aruna guided LPAs on a tour of the facility, at which time a census of 19 preschool children supervised by 3 staff were observed. All individuals subject to criminal background review have obtained criminal record clearance. During the inspection, Director, Nicole Bran, was at the facility. Hours of operation is Monday thru Friday 9:00 am- 4:30 pm.

A health and safety inspection was conducted in the classrooms, restrooms, food service areas, and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster,and daily schedule. The facility does not provide lunch or snacks, no menus were observed. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Medications are stored, inaccessible to children. No children currently on medication. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Bins for solid waste in the kitchen have tight fitting lids. The floors appeared clean throughout the facility. Program has parents provide all food at this time.

The children supply their own water bottles for indoor and outdoor water supply. LPA observed electronic sign in and sign out sheet. Playground equipment and surfaces are free of loose or sharp parts. LPA observed bark, sand and grass cushioning beneath the play structure. Outdoor shade is provided by trees and patio coverings. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector.


LPA reviewed staff files. At least one staff member present today has current Pediatric CPR and First Aid certification. Two staff members mandated reporter training certificate are expired and one staff member is missing proof of measles. LPA observed documentation of the educational background, training, and/or experience. http://www.mandatedreporterca.com/ (Report continues on 809-C)
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CREATIVE SPIRIT LEARNING CENTER
FACILITY NUMBER: 343623141
VISIT DATE: 03/28/2023
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LPA reviewed children's records which are kept electronically. Each child's file contained an emergency card, consent for emergency medical treatment, health history and notifications of children’s and parent’s rights.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. Currently, the facility does not have any children on medication. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 513-0301 (voice)/(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.html



Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

Exit interview conducted and report was reviewed with the licensee Aruna Sankari. A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Two Type B citations were issued during today's inspection notated on 809-D.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/28/2023 04:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: CREATIVE SPIRIT LEARNING CENTER
FACILITY NUMBER: 343623141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that one staff does not have proof of measles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/28/2023
Plan of Correction
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Director, Nicole Brann, will email LPA L. Habtom a copy of the measles test results for the staff member by POC date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that two staff members had expired mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/28/2023
Plan of Correction
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Director, Nicole Brann, will email LPA L. Habtom a copy of the mandated reporter training certificates for staff by POC date.
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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3