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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300340
Report Date: 01/09/2025
Date Signed: 01/09/2025 04:04:00 PM

Document Has Been Signed on 01/09/2025 04:04 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CREATIVE LEARNING CENTERFACILITY NUMBER:
376300340
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ,MARIAFACILITY TYPE:
830
ADDRESS:650 DOUGLAS DR #101TELEPHONE:
(760) 805-6478
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: 12TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
01/09/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:01 PM
MET WITH:Maria Hernandez TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 01/09/2025 at 1:25 pm, Licensing Program Analysts (LPAs) Gabriela Hernandez and Kelly Gerth arrived unannounced at the facility and met with Facility Representative Rebecca Morales to conduct a plan of correction visit from the annual inspection conducted on 12/06/2024. LPAs toured the facility, and took census. Director Maria Hernandez arrived approx. 30 minutes later.

As of the date and time of this visit, the Plan of Correction for deficiency 101430(a)(3)(A)(4)(a) not been met as evidenced by:

LPA reviewed LIC9227 on file for all infants under the age of 12 months. LPA interviewed Director whom confirmed C1 is able to roll from their back to their stomach, and stomach to their back. LPA observed that section D of the LIC9227 has not been signed by the provider.

For the above reasons, the facility is being cited for deficiencies, See LIC809D for cited deficiencies of the California Code of Regulations (Title 22, 101430(a)(3)(A)(4)(a) Infant Care Activities) are being cited on the attached LIC 809D.

LPA was able to verify the plan of corrections for all other deficiencies cited on 12/06/2024 have been met.

An exit interview was conducted with Director, Maria Hernandez.

Appeal Rights were discussed and provided to Director, Maria Hernandez.

A Notice of Site visit was given, Director Maria Hernandez, was reminded the notice must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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 2
Document Has Been Signed on 01/09/2025 04:04 PM - It Cannot Be Edited


Created By: Gabriela Hernandez On 01/09/2025 at 03:30 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CREATIVE LEARNING CENTER
FACILITY NUMBER: 376300340

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2025
Section Cited
CCR
101430(a)(3)(A)(4)a

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101430(a)(3)(A)(4)(a) Infant Care Activities (A) Staff shall place infants up to 12-months of age on their backs for sleeping. (4) Infants with an Individual Infant Sleeping Plan [LIC 9227 (3/20)] that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep. In the event the infant changes position, the infant may remain in the alternative position. (a) Upon staff observation that the infant is capable of rolling from their back to their stomach and stomach to their back, the provider shall fill out Section D of the Individual Infant Sleeping Plan [LIC 9227 (3/20)], notify the authorized representative, and obtain the authorized representative's signature on the individual sleeping plan no later than the next business day following observation.
This requirement is not met as evidenced by:
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Director stated they will review infant safe sleep regulations and will submit plan to LPA on how they will ensure they follow infant safe sleep regulations.
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Based on record review and interview, the licensee did not comply with the section cited above as the rolling section of the infant sleeping plan is not throughly completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
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