384004111-12-7-2022-05-CC-LGOZ-CLVRHU-20221207120256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004111
Report Date: 12/07/2022
Date Signed: 12/07/2022 12:03:10 PM

Document Has Been Signed on 12/07/2022 12:03 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:	384004111
ADMINISTRATOR:	LAU, AGNES		FACILITY TYPE:	830
ADDRESS:	1429 VALENCIA STREET		TELEPHONE:	(415) 577-8389
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 15	DATE:	12/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Nina Johnson, Agnes Lau		TIME COMPLETED:	12:15 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 12/7/2022 at 8:45AM., Licensing Program Analyst, Luis J. Gomez met with Program Coordinator, Nina Johnson. Purpose of the inspection was explained and was for an Unannounced, Annual/ Random inspection. Facility is a Combination Center with a Preschool/ Toddler program on-site. Director, Agnes Lau arrived during today’s inspection. Present was the director and six staff supervising 15 children. Children present have been signed-in by authorized representative. Staff have criminal record clearances are on file. Infant program utilizes one classroom and one outdoor play area. Days and Hours of operation are Monday- Friday 7:30am- 6:00pm. Program operates year-round. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 8:50AM., LPA observed the following: Infant classroom was clean, orderly, with age-appropriate toy and playthings available. Ground surfaces were free of hazards or potential obstructions. Infant classroom is separated into activity areas which include: Recreation and Napping Areas. Classroom is equipped with infant chairs for food services. Infant chairs inspected are wide- based and made with moist resistant material. Furnishings and walls inspected were free of sharp points/ corners. Classroom had individual cubbies for added storage. Classroom has diaper changing table is within arm’s reach of a sink.

At 9:05AM., Based on observations, LPA confirmed infant inside baby bouncer in infant play area. Chair was removed during inspection. Advisory Note: Technical Violation (9102TV) was issued during inspection.

Per director, changing table is disinfected after each use, and trash bins are emptied daily. Food preparation area/ sink is located separately and is equipped with refrigerator. Milk and food items inspected have been properly stored and labeled. For napping services, each infant had their own designated crib/ stackable cot. Each crib is equipped with tight-fitting sheet, properly sized mattress and free of any loose articles/ objects. Infant crib’s design allows for constant supervision. Per director, napping linins are changed daily (REFER TO 809C, FOR CONT.).

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: 384004111
	VISIT DATE: 12/07/2022

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
26
27
28
29
30
31
32

(PAGE 2)
Classroom had acceptable ventilation and lighting. Trash bins and outlets have been properly covered. Staff restroom is located in facility hallway. Detergents; cleaning supplies; compounds and sharp objects were inaccessible. Classroom has carbon monoxide/ smoke combination detector (built into building), fire alarm, and fully charged fire extinguisher (2A10:BC).

At 9:25AM., LPA inspected the outdoor play area. LPA observed area was completely enclosed. Area was clear of debris or other hazardous items. Play items were in like-new condition.

9:50AM., LPA reviewed the facility and children's records. Record review included five children’s files and five personnel files. Personnel record included: ‘Mandated Reporter Training’ certification (AB1207); Notice of Employee Rights (LIC9052); Declaration to Report Suspected Child Abuse (LIC9108); Teacher Qualification; Required Immunization; and Criminal Record Statement (LIC508).

Director had their current Cardiopulmonary Resuscitation/ First Aid Certification on file, which expires: 03/2024.

Children files were reviewed and included: Infant’s Needs and Services Plan; Identification of Emergency Information (LIC700); Immunization Records; Napping Logs; Individual Infant Sleeping Plan (LIC9227); Physician's Report (LIC701); and Admissions Agreement.

Per director, emergency drills are being conducted every six months, with last drill done: 11/15/2022, properly logged.

Required posting were observed in the facility lobby. Posting are properly posted in facility and include: Childcare license; Notification of Parent’s Rights (PUB995A); Emergency Disaster Plan(LIC610); and Passenger Safety Laws.
(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: 384004111
	VISIT DATE: 12/07/2022

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
26
27
28
29
30
31
32

(Page 3)
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

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 cited in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report was reviewed with Director, Agnus Lau and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided 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: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4