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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004111
Report Date: 06/05/2024
Date Signed: 06/05/2024 10:06:37 AM

Document Has Been Signed on 06/05/2024 10:06 AM - 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: 13DATE:
06/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Assistant Director, Nina Johnson TIME VISIT/
INSPECTION COMPLETED:
10:10 AM
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On 6/5/2024 at 8:50AM., Licensing Program Analyst (LPA) Luis Gomez and met with Assistant Director, Nina Johnson. The purpose of today’s inspection was explained and was for an unannounced, plan of correction inspection. Per assistant director, site director is not present today. Present was the assistant director and 6 staff caring for 13 children. Infants present were signed-in by guardians. LPA inspected facility for health and safety hazards.

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

At 9:00AM LPA observed infant classroom operating within proper Staff-Infant ratio.

Assistant director submitted to LPA an updated personnel report with schedule (LIC500). Personnel Report submitted shows two qualified teachers present in the infant classroom at all times.

Deficiency issued on 4/9/2024, has been cleared, and ‘Cleared Plan of Correction Letter’ was provided.

Based on today's inspection, no deficiencies were observed in areas evaluated according to the Title 22 Division 12, Chapter 1 Ca Code of Regulations. Exit interview and report was discussed with Assistant Director, Nina Johnson. Signature of this form acknowledges receipt of these documents.

This report must be available in facility for public review. Notice of site visit was provided and shall remain posted for 30 days. Staff was advised for questions to contact the Regional Office, Mon- Fri, 8:00am-5:00pm, 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: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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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