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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004110
Report Date: 11/01/2021
Date Signed: 11/01/2021 04:22:18 PM

Document Has Been Signed on 11/01/2021 04:22 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CREATIVE GARDENSFACILITY NUMBER:
384004110
ADMINISTRATOR:LAU, AGNESFACILITY TYPE:
850
ADDRESS:1429 VALENCIA STREETTELEPHONE:
(415) 577-8389
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 37DATE:
11/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Director, Agnes LauTIME COMPLETED:
04:30 PM
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On 11/01/2021 at 11:50A.M., Licensing Program Analyst, Luis J. Gomez met with Director, Agnus Lau. Purpose of the inspection was explained and is for an unannounced Annual/ Random inspection. Facility operates a Preschool Program with Toddler Option. Present was the director and 10 staff (8 Teachers, 2 Aides) supervising 37 children. All staff have their criminal record clearances on file. Program utilizes three classrooms: Toddler #1 (1.5 – 2.5 year olds), Preschool #1 (2.5- 3.5 year olds), Preschool #2 (3.5 – 5 year olds) and the Outdoor Play Yard. Hours of operation are Monday- Friday 7:30am- 6:00pm. Program operates year around. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 12:00A.M., LPA observed the following: Classrooms inspected were clean, orderly with a variety of age-appropriate toys, blocks and playthings for the children. All floors and surfaces were free of obstruction. Accessible furniture was in good repair. Manipulative were free of sharp edges or splinters. LPA observed several child size tables and chairs for snack and actives. The children's bathrooms are maintained in safe and sanitary condition. Staff restrooms are located in the hallway. Toddler classroom was equipped with diaper changing table, within reach of as sink. Classrooms had labelled cubbies for storage of children's belongings. For nap time, cots had been assigned to each child. Per director, children's blankets are washed weekly. Classrooms had acceptable ventilation and lighting.

At 12:12P.M., LPA observed accessible trash cans without tight fitting covers. Technical Violation (9102TV) was issued during inspection. Detergents, cleaning supplies and toxins are made inaccessible, stored in an off-limits areas. Facility had a smoke/ carbon monoxide detector combo and several fully charged fire extinguishers (2A:40BC). First aid kit had been reviewed and is fully stocked. (REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CREATIVE GARDENS
FACILITY NUMBER: 384004110
VISIT DATE: 11/01/2021
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(Page 2)
At 12:30P.M., LPA inspected the outdoor play area. LPA observed outdoor play area is completely enclosed with tall fencing. Outdoor play area is kept clean, free of debris and hazardous items. Play structure was properly anchored. Toddler/ Preschool activity schedule was provided during inspection. Per director, water service is provided outside with large refillable containers. Water containers are refilled daily.

At 12:45P.M., LPA review facility records including ten children’s files and ten personnel files. Children files reviewed were complete and included: Health History (LIC702), Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Immunization Records and Signed Admissions Agreement. Staff files were also reviewed and included: Proof of Immunization, Health Screening (LIC503), Declaration to Report Suspected Child Abuse (LIC9108) and Notice of Employee Rights (LIC9052). LPA reminded director to ensure all staff have their updated mandated reporter training on file.

Present staff members had their current CPR/ 1st aid certification which expires: 1/2023. Emergency drills are conducted at the facility, with the last drill done on 9/29/2021, properly logged. Per Director, parents provide all meals for day-care children. Facility provides daily snack. Updated snack schedule was observed during inspection. Facility kitchen, refrigerator and food containers were reviewed during inspected. All food inspected was current and properly stored. Required posting was observed in the facility entry way including: License, Parents Rights (PUB393), Emergency Disaster Plan (LIC610) and LIC613A.

During inspection, LPA reviewed children’s medication stored in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

(REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CREATIVE GARDENS
FACILITY NUMBER: 384004110
VISIT DATE: 11/01/2021
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Director 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

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

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Director, Agnus Lau and her signature of this form acknowledges receipt of these documents.



This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
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