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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624644
Report Date: 02/14/2023
Date Signed: 02/14/2023 01:26:58 PM

Document Has Been Signed on 02/14/2023 01:26 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:CREEKSIDE PRESCHOOL & INFANT CENTERFACILITY NUMBER:
343624644
ADMINISTRATOR:TBDFACILITY TYPE:
830
ADDRESS:2550 BELPORT LANETELEPHONE:
(916) 276-0279
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: DATE:
02/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ginette Stephens, Roberta Manley, Christina Diaz BushmanTIME COMPLETED:
01:45 PM
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Application Specialist (AS) Mai Lor and Licensing Program Analyst (LPA) Karyn Guerra met with Applicant Ginette Stephens for the purpose of an announced pre-licensing inspection. Present during this inspection are Site Director Roberta Manley and Christina Diaz Bushman . Applicant is requesting an infant license to serve 10 infant children from birth to 24 months and 11 toddler children age 18-36 months in the Toddler Option Program. Total capacity requesting is 21 infant children. The program will operate Monday through Friday from 6:00 AM to 6:00 PM. The fire clearance was granted on 02/06/2023 with the following condition: upstairs not approved for daycare.

AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule.

Applicant stated the Needs and Services plans will be kept in the classrooms. The facility will provide morning and afternoon snacks, breakfast, and lunch. Parents will provide formula, breast milk, and baby food for their children.

INDOOR ACTIVITY SPACE:
There is one infant classroom and one Toddler Option classroom. The classrooms are equipped with sufficient infant size furnishing, cubbies and a variety of age-appropriate toys that appear to be in good repair. AS observed 8 cribs in the napping room. Applicant acknowledges there will be a maximum of 8 infants under 12 months old, due to available cribs. The napping area is physically separated from the activity space. AS observed the classrooms to be clean, safe, sanitary and in good repair. AS observed containers used for storage of solid wastes, including moveable bins, to have a tight-fitting cover that is kept on and in good repair. Applicant was reminded that toddler option children cannot be co-mingled with the infant children. (Report continued on subsequent LIC 809)
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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
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: CREEKSIDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 343624644
VISIT DATE: 02/14/2023
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There is a first aid kit located in the office. Medication will be stored in a locked box in the kitchen and inaccessible to children in care. AS observed cleaning disinfectants appropriately stored and inaccessible to children. Applicant stated there are no firearms or weapon on the premises. Applicant stated indoor and outdoor drinking water will be provided to children by Brita water filter and water bottles. AS observed carbon monoxide detectors throughout the facility. AS and LPA observed a paper sign in and sign out system.

AS measured the classrooms. The total classroom space contains a total of 744.37 square feet, which will accommodate Applicant's requested capacity for 10 infant children and 11 Toddler Option children. There are three sinks available in the classrooms. There are three toilets and three sinks available to children use. AS did not observed potty chairs in the classrooms. The applicant was reminded that there shall be one potty chair to every five infants being toilet trained. AS observed one changing table with a changing pad that is at least one inch think with raised sides that are at least three inches tall and within arm’s reach of a sink in each of the classrooms. Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is an outdoor activity space for infant children. Applicant submitted a waiver to share the infant playground with the toddler option children with a rotating schedule. The applicant was reminded to use age-appropriate equipment and toys. The outdoor play area is surrounded by a iron rod fence that is at least four feet tall. No play structure or climbing structure were observed. Applicant stated the playground will be modified in the future to fit the needs of the center. Applicant was reminded to inform the department prior to construction or alteration. The outdoor space is shaded by trees and overhangs.

As measured the outdoor activity space. The outdoor play area contains a total of 2792.93 square feet, which will accommodate Applicant's request for 10 infant children and 11 toddler option children.

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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: CREEKSIDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 343624644
VISIT DATE: 02/14/2023
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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)/ (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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Applicant 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.



Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

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 platform.

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.

AS provided and discussed Health and Safety Code 1596.956 regarding the toddler option with Applicant.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CREEKSIDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 343624644
VISIT DATE: 02/14/2023
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Applicant stated the upstairs building will be rented out in the future. Applicant was reminded that all future tenants residing in the upstairs building will require a criminal record clearance per Health and Safety Code 1596.871(b)(1).

The facility application was reviewed and approved by Licensing Program Manager Seychelle De Luca prior to this inspection. Effective today, 2/14/23, AS grants an infant license childcare license to serve 10 infant children from birth to 24 months and 11 toddler children age 18-36 months in the Toddler Option Program. Total capacity is 21 infants.

Exit interview conducted and report was reviewed with the Applicant, Ginette Stephens.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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