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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004111
Report Date: 01/10/2023
Date Signed: 01/10/2023 11:32:38 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/21/2022 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20221221091012
FACILITY NAME:CREATIVE GARDENSFACILITY NUMBER:
384004111
ADMINISTRATOR:LAU, AGNESFACILITY TYPE:
830
ADDRESS:1429 VALENCIA STREETTELEPHONE:
(415) 577-8389
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:20CENSUS: 12DATE:
01/10/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Agnus LauTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff is providing unsafe equipment.
INVESTIGATION FINDINGS:
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On 1/10/2023 at 8:30AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Agnus Lau. Purpose of the inspection was explained and was for unannounced; complaint investigation. Present was the director and 5 staff supervising 12 children. LPA inspected facility for health and safety hazards.

During inspection, LPA performed observations and interviewed staff/ director.

During the course of the investigation, site observations were conducted on 12/22/2022 and 1/10/2023 . A review of the facility records was also complete, which included the staff roster, children’s roster, and parent handbook. LPA conducted interviews with director, staff and all involved parties.
(REFER TO 9099C FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 05-CC-20221221091012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 384004111
VISIT DATE: 01/10/2023
NARRATIVE
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(PAGE 2)
Regarding the allegation of facility staff providing unsafe equipment; Based on observation and interviews, LPA confirmed staff using equipment (Bib) to prop-up bottle during infant feeding. Equipment was removed from infant classroom during inspection.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation(s) are found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) are being cited on attached 9099D. Appeal Rights were provided to director.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal rights were discussed.

Signed copy of this report was provided to the director.

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

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20221221091012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 384004111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
101427(h)
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101427(h) Infant Care Food Services: (h) Infants who are unable to hold a bottle shall be held by a staff person or other adult for bottle feeding. At no time shall a bottle be propped for an infant. An infant shall not be allowed to carry a bottle while ambulatory. This requirement is not met as evidenced by:
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Director will submit updated children's roster to the department showing feeding strategy, staff member assigned, and time service will be provided by the due date: 1/16/2022.

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Based on observation and interviews, LPA confirmed, LPA confirmed staff using equipment (Bib) to prop-up bottle during infant feeding. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the department 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.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3