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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515407313
Report Date: 06/29/2023
Date Signed: 06/29/2023 12:47:37 PM

Document Has Been Signed on 06/29/2023 12:47 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CREATIVE KIDS PRESCHOOL AND DAYCAREFACILITY NUMBER:
515407313
ADMINISTRATOR:MICHELLE LIGHTLEFACILITY TYPE:
850
ADDRESS:1015 MARCIA AVENUETELEPHONE:
(530) 751-0678
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 17DATE:
06/29/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:LeeAnn DeluzeTIME COMPLETED:
12:50 PM
NARRATIVE
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On June 29, 2023, Licensing Program Analyst (LPAs) J. Helton and J. Gifford conducted a case management visit for uncleared POC's.

The following deficiencies were cited, Type B violation for failure to complete water lead testing no later than January 1, 2023. Type B violation for failure to have staff complete required mandated reporter training. (see LIC 809D):

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director LeeAnn Deluze.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jackie Helton
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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Document Has Been Signed on 06/29/2023 12:47 PM - It Cannot Be Edited


Created By: Jackie Helton On 06/29/2023 at 12:33 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CREATIVE KIDS PRESCHOOL AND DAYCARE
FACILITY NUMBER: 515407313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/13/2023
Section Cited
HSC
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
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Licensee will provide scheduled lead sample date to LPA by 7/13/2023
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Based on interview, the licensee did not comply with the section cited above in 1 out of 1 requrement facility which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/13/2023
Section Cited
HSC1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
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Director will provide copies of mandated reporter certificates to LPA via email.
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Erin Virrueta
LICENSING EVALUATOR NAME:Jackie Helton
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
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