384004110-11-1-2022-05-CC-LGOZ-CKRRFL-20221101125920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004110
Report Date: 11/01/2022
Date Signed: 11/01/2022 01:00:15 PM

Document Has Been Signed on 11/01/2022 01:00 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 GARDENS		FACILITY NUMBER:	384004110
ADMINISTRATOR:	LAU, AGNES		FACILITY TYPE:	850
ADDRESS:	1429 VALENCIA STREET		TELEPHONE:	(415) 577-8389
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 56	TOTAL ENROLLED CHILDREN: 56	CENSUS: 42	DATE:	11/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Nina Zelisa Johnson, Agnes Lau		TIME COMPLETED:	01:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/1/2022 at 9:05AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Program Coordinator, Nina Johnson. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Director, Agnes Lau arrived during inspection. This program is a preschool program and toddler option. Infant program is also located on-site. Present was the Director and 11 staff supervising 42 children. Staff have criminal record clearances on file. Children present were signed in by authorized representative. Preschool program utilizes three classrooms: Toddler Room, 18 -36 months old; Preschool #1, 2- 3 year old; Preschool Classroom #2; 3- 5 year old; and one, shared, Outdoor Play Area. Day and hours of operation are Monday- Friday, 7:30AM- 6:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 9:15AM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floor and ground surfaces were free of obstructions. Accessible furniture and learning materials inspected were in proper repair, and free of any sharp/loose parts. Classrooms were equipped with labeled cubbies for storage of children’s belongings. Classroom had child sized tables and chairs for snack and seated activities. At 9:20AM., Based on observations, LPA confirmed broken toilet paper dispenser in toddler bathroom. Advisory Note: Technical Violation (LIC9102TV) was issued. Children’s bathrooms are located inside each classroom, with adequate supplies for children’s hand washing. Fixtures tested were operating condition. Toddler bathroom and is located separately and is maintain clean. For napping services, cots are stacked inside each classroom. Per director, napping supplies are washed weekly by families. LPA reminded director to ensure children’s beddings do not come in contact with other beddings. Facility was the proper temperature, with ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins are stored in off-limit areas. Electrical outlets, vents, and trash bin have been covered. Classrooms had functioning carbon monoxide detector; smoke detector (Built-in); and three (fully charged) fire extinguishers; 2A:10BC. Facility’s first aid kit was reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CREATIVE GARDENS	FACILITY NUMBER: 384004110
	VISIT DATE: 11/01/2022

NARRATIVE

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(Page 2)
At 10:00AM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed with tall fencing. Area was free of debris or hazardous plants. Play structures are anchor and rubber padding has been added for increased safety. Per director, water services are provided with use of refillable water bottles and pitchers, brought outside by staff. LPA reminded director to ensure drinking water is readily available at all times.

Children’s food, and the snack preparation area was reviewed. Food items inspected were current and properly stored. Area was observed clean, free of liter or rubbish.

At 10:25AM, LPA reviewed the facility records including five children’s files and eight personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement (LIC508); Proof of Teacher Qualification; Required Proof of Immunization; and updated ‘Mandated Reporter Training’ Certification (AB1207).

Children’s files were reviewed and included: Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Health History (LIC702); and Notification of Parent’s Rights (LIC995); and Physician’s Report (LIC701).

Facility is documenting each 15- minute napping checks for qualifying infants in care. Logs were reviewed during inspection.

Director’s ‘Cardiopulmonary Resuscitation / First Aid’ certification was current, expiring: 1/2023. Emergency disaster drills are conducted by the facility, with last drill conducted, 10/25/2022, properly logged.

Required forms and posted in facility and include: Childcare License; Outdoor Space Waiver; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB394); Updated Snack Menu; and Updated Emergency Disaster Plan (LIC610).

Children’s medication and incidental medical services (IMS) were reviewed and discussed.
(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CREATIVE GARDENS	FACILITY NUMBER: 384004110
	VISIT DATE: 11/01/2022

NARRATIVE

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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.

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

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

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 and report was reviewed with Director, Agnes Lau, and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call Regional 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: 11/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC809 (FAS) - (06/04)

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