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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004111
Report Date: 04/09/2024
Date Signed: 04/09/2024 01:10:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
04/02/2024 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240402085222
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: 11DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Agnes LauTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are operating out of ratio.
INVESTIGATION FINDINGS:
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On 4/9/2024 at 8:10AM., Licensing Program Analyst, (LPA) Luis Gomez met with Assistant Director, Nina Johnson. The purpose of inspection was explained and was for an unannounced, complaint inspection. Present is facility was Assistant Director and 2 staff supervising 6 children. During inspection, 5 additional children and Director, Agnes Lau arrived to facility. Children present had been signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA performed interviews, record review and observations.

During the course of this investigation, observations were conducted on 4/9/2024. A review of facility records was complete, which included the Children’s File, Staff Files and Sign-In Logs. LPA conducted interviews with Director, Staff, and Involved Parties. (REFER TO LIC9099c, FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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-20240402085222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 GARDENS
FACILITY NUMBER: 384004111
VISIT DATE: 04/09/2024
NARRATIVE
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(PAGE 2)
Regarding the allegation of staff are operating out of ratio; Based on evidence collected, LPA determine allegation made is valid.

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

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 appeal rights were discussed with director, Agnes Lau.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20240402085222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 GARDENS
FACILITY NUMBER: 384004111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2024
Section Cited
CCR
101416.5(b)
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101416.5(b) Staff-Infant Ratio. (b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement was not met as evidenced by:
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Director will submit an updated staff roster and schedule to the Department by the due date: 4/12/2024.
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Based on evidence collected, LPA determine facility operating out of the required Infant-Staff ratio(4:1). 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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3