434414100-1-8-2026-07-CC-MJVA-DQ5V5L-20260108150807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414100
Report Date: 01/08/2026
Date Signed: 01/08/2026 03:08:22 PM

Document Has Been Signed on 01/08/2026 03:08 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CREATIVE EXPLORERS		FACILITY NUMBER:	434414100
ADMINISTRATOR/ DIRECTOR:	DARCY HELLUMS		FACILITY TYPE:	850
ADDRESS:	604 E. EVELYN AVE.		TELEPHONE:	(408) 685-2863
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 35	CENSUS: 14	DATE:	01/08/2026
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Ann Doan, Co-Director		TIME VISIT/ INSPECTION COMPLETED:	03:15 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 January 8, 2026, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva and Licensing Program Manager (LPM) Mireya Flores met with Ann Doan, Co-Director/Teacher and Darcy Hellums, Licensee/Director, for an unannounced Required 3 year Inspection. LPA & LPM toured the indoor and outdoor areas of the Facility during today's inspection. LPA & LPM observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), menus, and Activity Schedule. Days and hours of operation are Monday through Friday 8:00am to 5:30pm. The Facility is licensed to serve a maximum of forty five (45) children ages two to entry into 1st grade in the Preschool Classroom #1, Classroom # 2 and Art/food preparation Area. The Facility has two active waivers on file (playground space and electronic sign in and sign out) and is in compliance with the conditions of both waivers. Per Co-Director at this time the facility is using paper sign in/out sheets. LPA observed and reviewed sign in/out sheets. LPA reviewed four (4) children's and six (6) staff files during today's inspection. Each child's file reviewed contains the required documents, including the Information and Emergency Information form (LIC 700) and immunization records. Staff files reviewed contain the required documents, including transcripts/verification of experience/immunization records, and Health Screening Report. During LPA reviewed of Staff # 4 file, MMR vaccine record was missing. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on October 6, 2025. Staff have current CPR and First Aid certifications on file. Co-Director Ann and Darcy understand that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Report continues on next page 1 of 3.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE EXPLORERS	FACILITY NUMBER: 434414100
	VISIT DATE: 01/08/2026

NARRATIVE

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LPA and LPM observed that the teacher/child ratio was in compliance during today's inspection. During LPA's and LPM's arrival 14 children with five teachers in the Facility were observed during today's inspection. Co-Director Ann Doan understands the conditions, limitations, and capacity specifications of the Facility license. Co-Director Ann Doan understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who becomes ill during the day, shall be isolated in the lobby area.

LPA and LPM observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. The Facility has adequate ventilation, including central air conditioning/heating. Co-Director Ann Doan states that they and staff clean the Facility Monday through Friday in the evenings. Co-Director Ann Doan understand that the Facility must be kept free of flies and other insects & rodents. LPA and LPM observed that all furniture and equipment is in good condition and safe for children.

Drinking water is readily available for the children in the Facility and in the outdoor playground area water bottles were observed. Staff and children's bathrooms are clean, sanitary, and operable. At 8:47AM during a walk through LPA and LPM observed a water drop leak coming from the sink drain pipe in the children bathroom near classroom # 1. Per Co-Director stated a service order has been placed for repair. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Co-Director Ann Doan states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detector in the Art/food preparation area. At 10:16AM LPM tested carbon monoxide detector and it is operable condition.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers. Per Co-Director Ann Doan, the Facility provides breakfast, AM and PM snacks to the children. Parents provide lunches for the children. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Co-Director Ann Doan states that there are no poisons in the Facility. LPA observed a complete First Aid kit in the Facility. Co-Director Ann Doan understand that smoking is not allowed on the Facility premises.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. At 9:15AM LPA and LPM observed expired medication for Child #1, Child #2 and Child #3 (pictures were taken). 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/. Report continues on next page 2 of 3.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE EXPLORERS	FACILITY NUMBER: 434414100
	VISIT DATE: 01/08/2026

NARRATIVE

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The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is a secure play structure that is age appropriate for the preschool children. There is sufficient cushioning materials (rubber padding) under and surrounding the play structure. Shade is provided by building overhangs and umbrellas. LPA did not observe any bodies of water in the outdoor area. Co-Director Ann Doan states that the Facility does not provide transportation.

Co-Director Ann Doan 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.

Co-Director Ann Doan 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

During today’s inspection the following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

Exit interview conducted and report was reviewed with the Licensee/Co-Director, Ann Doan. A notice of site visit was given and must remain posted for 30 days and Appeal Rights were reviewed and a copy was provided.

Report ends here page 3 of 3.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/08/2026 03:08 PM - It Cannot Be Edited

Created By: Martha Jimenez-Villanueva On 01/08/2026 at 02:01 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CREATIVE EXPLORERS	FACILITY NUMBER: 434414100
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA and LPM observations and records review, the licensee did not comply with the section cited above in Child # 1, Child # 2 and Child # 3, medications were expired which poses a potential health, safety risk to persons in care.
	POC Due Date: 01/12/2026
	Plan of Correction
1 2 3 4	During today inspection Co-Director, Ann Doan contacted parents to notify new medications needs to be replace or if medications are no longer needed Co-Director will obtain a written notification from parents. Per Co-Director will submit proof of completion via email to LPA Jimenez-Villanueva by the end of business day of 01/12/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Susy Cervantes
NAME OF LICENSING PROGRAM MANAGER:

	Martha Jimenez-Villanueva
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC809 (FAS) - (06/04)

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