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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804044
Report Date: 02/02/2024
Date Signed: 02/02/2024 12:28:48 PM

Document Has Been Signed on 02/02/2024 12:28 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
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: 12DATE:
02/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Danielle Guisande, Program ManagerTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa made an unannounced Annual Inspection Licensing of this licensed facility on 2/2/24 at approximately 9:45 AM and met with Program Manager Danielle Guisande. This facility operates Monday through Friday between 9:00 AM to 3:00 PM.

LPA and Program Manager toured the building and grounds which were found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required have been posted and are in a highly visible area. LPA observed clients participating in activities and/or eating lunch with adequate staff support. Toxins are stored in a locked housekeeping closet in the hallway. Fire extinguishers were inspected on 1/10/2024 and were fully charged. Smoke detectors and fire sprinklers were tested by the fire department on 1/10/2024. There was adequate lighting in all common areas and walkways. Each activity room was clean and furnished appropriately for clients and staff. There was a disinfection station in the Care Room, which also had a washer and dryer and storage for backpacks that contain clients' care needs (sunscreen, etc.) in case of emergency. (4) Bathrooms were clean and sanitary and stocked with antibacterial hand soap and paper towels. The kitchen was clean and well-organized for client and staff use. There was a large dining area for clients to enjoy lunch and socialize with staff supports. There were gloves and hand sanitizer placed throughout the facility.

No deficiencies were observed at the time of inspection. No citations were issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
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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