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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004111
Report Date: 05/23/2024
Date Signed: 05/23/2024 12:00:55 PM

Document Has Been Signed on 05/23/2024 12:00 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CREATIVE GARDENSFACILITY NUMBER:
384004111
ADMINISTRATOR/
DIRECTOR:		LAU, AGNESFACILITY TYPE:
830
ADDRESS:1429 VALENCIA STREETTELEPHONE:
(415) 577-8389
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 14DATE:
05/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Agnes LauTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 5/23/2024 at 10:40AM., Licensing Program Analyst (LPA) Luis Gomez and met with Director, Agnes Lau. The purpose of today’s inspection was explained and was for an unannounced, plan of correction inspection established on 4/11/2024. Present was director and 5 staff caring for 14 children. LPA inspected facility for health and safety hazards.

During inspection, LPA conducted record review, observation, and interviews.

At 11:12AM., Based on record review, observation and interviews, LPA confirmed Infant classroom operating out of ratio with 13 infants- age children and 1 qualified teacher present. Per director, she was needed to provide coverage in preschool classroom. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA reminded director to ensure staff provide constant visual and direct supervision of napping infants at all times. Advisory Note: Technical Violation (LIC9102TV) was issued.
Director submitted an updated staff roster (LIC500).

Exit interview and facility evaluation report was discussed with Director, Agnes Lau. Director's signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. The director 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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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