384004111-6-25-2026-05-CC-LGOZ-DVDRPX-20260625131239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004111
Report Date: 06/25/2026
Date Signed: 06/25/2026 01:12:58 PM

Document Has Been Signed on 06/25/2026 01:12 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 GARDENS		FACILITY NUMBER:	384004111
ADMINISTRATOR/ DIRECTOR:	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: 14	DATE:	06/25/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:55 AM
MET WITH:	Agnes Lau		TIME VISIT/ INSPECTION COMPLETED:	01:25 PM

NARRATIVE

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On 6/25/2026 at 8:55AM., Licensing Program Analyst (LPA), Luis Gomez met with Teacher, Nina Johnson. The purpose of today's visit was explained and was for an unannounced- annual random inspection. This facility is combination center with a preschool program onsite. The director, Agnes Lau arrived during inspection. Present was Director and 5 staff supervising 14 children. The facility has a sign/in sign out procedure; and each child present had been signed in by designated guardian. The day and hours of operation are Monday- Friday, 7:30AM- 6:00PM. The infant program utilizes one classroom, and a separate outside play area. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:25AM., LPA observed the following: infant classroom was neat and orderly with age-appropriate/ washable equipment available for the children. The doorways, carpeted floors and ground surfaces were observed clear of obstructions. The furniture, including padded climbing blocks and play items, were free of sharp corners or splintered edges. The infant classroom was equipped with several activity areas including general-use area; storage area; and activity/ carpeted space. The LPA observed cabinets and baskets available for storing classroom materials and supplies.

For feeding/ bottle services, LPA observed several chairs with removable tables and wide- based legs. The classroom was equipped with rocking chair for individual staff-child feeding. The classroom has a changing table, available for staff to perform diaper changes as needed. The changing table was within arm’s reach of a sink with nearby covered trash bins for disposal of solid waste. Per director, all solid waste is removed from the classroom throughout the day.

LPA advised director to ensure side of changing table has raised sides of at least 3 inches in height. Advisory Note: Technical Violation (LCI9102TV) was issued. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/25/2026

NARRATIVE

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For nap/ scheduled rest, LPA observed labelled cribs and several stackable cots. The infant cribs were located separately, and in an enclosed area. Each infant crib had a properly sized mattresses, was maintained clean and had a tight fitted sheet. Per director, napping sheets are changed/ washed onsite daily. The cribs have visibility on all sides to ensure constant staff supervision. The classroom had adequate ventilation, was well lit, and was a comfortable temperature for the children. The facility had a functioning telephone service; carbon monoxide detector (built into building); and fire extinguisher (2A10BC) located in hallway.

The LPA observed a separate bottle preparation/ bottle storage area with functioning refrigerator. The infant bottles had been labeled with each child’s name and had been dated.

Per director, the infant bottles are taken home daily to be cleaned and returned to the facility following day.

The cleaning detergents, toxins, and other hazardous items had been made inaccessible and stored on a high shelf.

At 9:50AM., LPA inspected the outside infant play yard. The area was completely enclosed, with turf padding installed for added safety. Per director, regrading water services refillable bottles and are available for children to drink as they wish.

At 10:15AM., LPA reviewed facility records including 3 children’s files and 4 personnel files. The staff files contained the: Notice of Employee Rights (LIC9052); Teacher Qualification; Personnel Record (LIC501); Proof of Mandated Reporter Training Course (AB1207); Immunization Record; and Health Screening/ TB Assessment (LIC503).

The children’s files were reviewed and included the: Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Immunization Record; Individual Infant Sleeping Plan (LIC9227) for qualifying infants; Infant Needs and Services Plan; and Signed Admissions Agreement.

The classroom logs confirm, staff are conducting and recording the infant nap checks during each every 15 minutes.

The staff present have their active CPR/ 1^st Aid Certification course on file, and it expires on: 7/2027. The facility emergency disaster drill (Fire and Earthquake) was completed on: 3/10/2026.

The mandated postings are posted in public accessible area (Lobby) and include the following forms: License Certificate; Emergency Disaster Plan (LIC610A); Notification of Parents Rights (LIC995A); Personal Rights Form (LIC613A); and CA Seat Belt Safety Laws. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/25/2026

NARRATIVE

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LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/25/2026

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were cited in the areas evaluated, according to Title 22, Division 12, Chap. 1 Ca. Health and Safety Code of Regulations. An exit interview was conducted including a review of facility evaluation report (FER) with Director, Agnes Lau. The signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility file for public review. The Notice of site visit was provided and must remain posted for 30 days. The director was advised for additional questions to contact the San Bruno Regional Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

LIC809 (FAS) - (06/04)

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