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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417011
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:22:13 AM

Document Has Been Signed on 12/08/2022 11:22 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CREATIVE EXPLORERS INC.FACILITY NUMBER:
434417011
ADMINISTRATOR:ANN DOANFACILITY TYPE:
850
ADDRESS:610 EAST EVELYN AVENUETELEPHONE:
(408) 685-2110
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 24TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ann DoanTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Ann Doan, director, for an unannounced Required - 1 Year inspection. LPA toured the indoor and outdoor areas of the Facility during today's inspection. LPA 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 twenty four (24) children ages two to entry into 1st grade in the one classroom. The Facility has one active waiver on file (playground space) and is in compliance with the conditions of the waiver.

LPA reviewed five children's and four staff files (1 director and 3 teachers) 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. All staff files reviewed contain the required documents; including transcripts/verification of experience/immunization records, and Health Screening Report. 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 November 21, 2022. All staff have current CPR and First Aid certifications on file. Ann understands 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).

LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 11 preschool children with two teachers in the Facility during today's inspection. Ann understands the conditions, limitations, and capacity specifications of the Facility license. Ann 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 become ill during the day, shall be isolated in the director’s office area.

LPA 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. Ann states that they and staff clean the Facility Monday through Friday in the evenings. Ann understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CREATIVE EXPLORERS INC.
FACILITY NUMBER: 434417011
VISIT DATE: 12/08/2022
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Drinking water is readily available for the children in the Facility and in the outdoor playground area via water dispensers/water bottles. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Ann states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in the Facility.

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 at 45 degrees F or less. The Facility provides breakfast and 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. Ann states that there are no poisons in the Facility. LPA observed a complete First Aid kit in the Facility. Ann states that the Facility does not administer any medications at this time. Ann understands that smoking is not allowed on the Facility premises.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The preschool playground is surrounded by appropriate fencing and the outdoor surfaces are safe for children. The playground equipment is age appropriate and artificial grass with rubber padding is used as resilient material. Shade is provided by the building overhang and umbrellas. Drinking water is available via pitchers/water bottles/disposable cups. There is adequate age appropriate supplies and toys for children in the playground. LPA did not observe any bodies of water during today's inspection. Ann states that the Facility does not provide transportation.

Ann was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

Exit interview conducted and report was reviewed with the Director, Ann Doan. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
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