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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804044
Report Date: 09/16/2022
Date Signed: 09/16/2022 11:29:56 AM

Document Has Been Signed on 09/16/2022 11:29 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KREATIVE COMMUNITY SERVICES - BLOOMFACILITY NUMBER:
486804044
ADMINISTRATOR:ALOE, SHAYNEFACILITY TYPE:
775
ADDRESS:1241 ALAMO DRIVE SUITE 7TELEPHONE:
(707) 474-9653
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 60CENSUS: 21DATE:
09/16/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Shayne AloeTIME COMPLETED:
11:46 AM
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Licensing Program Analyst (LPA) Katrina Walters made an unannounced Post Licensing inspection of this licensed facility and met with Executive Director, Shayne Aloe. This facility operates Monday through Friday between 9:00 AM to 3:00 PM.

LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed that all clients were participating in activities. Toxins are stored in a locked housekeeping closet in the hallway. Facility keeps a keeps a weekly and daily cleaning schedule, staff log that items have been disinfected. LPA observed a sufficient supply of cleaning products. Fire extinguishers inspected were charged. Smoke detectors were tested by the fire department found to be in working order. Facility has fire sprinklers throughout which were tested by the fire department on 1/20/22. There was enough lighting in all common areas and walkways. In each activity room there are disinfection stations for staff and clients with hand sanitizer and gloves. Bathrooms were stocked with antibacterial hand soap and paper towel.

No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2022
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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