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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004111
Report Date: 01/23/2023
Date Signed: 01/23/2023 03:15:50 PM

Document Has Been Signed on 01/23/2023 03:15 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
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: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
01/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Agnus Lau, Nina JohnsonTIME COMPLETED:
03:25 PM
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On 1/23/2023 at 2:15PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Lead Teacher, Nina Johnson. Purpose of the inspection was explained and was for an unannounced; Plan of Correction inspection. Present was the Lead Teacher and five staff caring for 16 children. Director, Agnus Lau arrived during inspection. All children have been properly signed in. LPA inspected facility for health and safety hazards.

During today’s inspection, LPA performed observations and interviews.

At 2:20PM., LPA inspected the infant classroom. All playthings inspected were in good repair. Classroom was free of hazards or dangerous conditions. Per director, feeding bibs have been removed from facility and will no longer be used.

On 1/13/2022, Facility submitted updated feeding plans with each infant’s name, time of bottle feeding, responsible staff member, and preferred strategy.

Notice of Site Visit (LIC9213) was observed visibly posted in facility lobby.

Deficiency issued on 1/10/2023, has been cleared and ‘Cleared Plan of Correction Letter’ was provided.

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 discussed with Director, Agnus Lau and signature of this form acknowledges receipt of these documents.

LPA unable to print copy of report during inspected. Signed report and Notice of Site Visit will be mailed to facility director.

This report must be available in the facility for public review. Notice was provided and must remain posted for 30 days. Licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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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