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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004110
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:34:16 AM

Document Has Been Signed on 08/28/2024 11:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CREATIVE GARDENSFACILITY NUMBER:
384004110
ADMINISTRATOR/
DIRECTOR:		LAU, AGNESFACILITY TYPE:
850
ADDRESS:1429 VALENCIA STREETTELEPHONE:
(415) 577-8389
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 35DATE:
08/28/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Agnes Lau, Nina JohnsonTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 8/28/2024 at 9:00AM. Licensing Program Analyst (LPA) Luis Gomez met with Program Coordinator, Nina Johnson. Program Director, Agnes Lau arrived during inspection. The purpose of Case Management report is to cite deficiencies observed during site inspection. LPA inspected facility for health and safety hazards.

At 10:30AM., Based on record review and interview, LPA confirmed proof of teacher qualifications (S1) missing from facility files.



Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 1, Health and Safety, Code of Regulations, and cited on 809D. Exit interview was discussed with Program Director, Agnes Lau, including the plans of correction and evaluation report. Director’s signature of this form acknowledges the receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. Director 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

LPA unable to print report with pertaining documents during inspection. Copy of report will be sent to facility at a later date.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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Document Has Been Signed on 08/28/2024 11:34 AM - It Cannot Be Edited


Created By: Luis Gomez On 08/28/2024 at 10:35 AM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CREATIVE GARDENS
FACILITY NUMBER: 384004110

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2024
Section Cited
CCR
101216.1(g)

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101216.1(g) Teacher Qualifications and Duties. A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center.

This requirement was not met as evidenced by:
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Director will ensure proof of teacher qualifications are stored in facility records by the due date: 9/5/2024.
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At 10:30AM., Based on record review and interview, LPA confirmed proof of teacher qualifications (S1) missing from facility files. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to LPA via email.

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
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