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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624644
Report Date: 07/14/2026
Date Signed: 07/29/2026 09:12:48 AM

Document Has Been Signed on 07/29/2026 09:12 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CREEKSIDE PRESCHOOL & INFANT CENTERFACILITY NUMBER:
343624644
ADMINISTRATOR/
DIRECTOR:		ANDERSON, KILEYFACILITY TYPE:
830
ADDRESS:2550 BELPORT LANETELEPHONE:
(916) 333-1169
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 21TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
07/14/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Ginette Stephens and Nicole MoranTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On July 14, 2026, Licensing Program Analysts (LPAs) Kyrsten Williams and Amanda Sutter met with facility representative, Ginette Stephens and Nicole Moran, for the purpose of a case management inspection. The purpose of the inspection was explained. Census included two children being supervised by one staff.

LPA Williams received and reviewed video footage that was taken approximately one to two years ago that recorded an infant child in a crib located in the infant classroom. LPA observed the child's body begin to shake. The child was looking around, their eyes occasionally rolling, and the child's mouth opening as well. The child did not make noise. Both of the child's arms jerked and shook quickly while their legs remained stiff and fluttered up and down. The video footage lasted for approximately two minutes until the child appeared to relax. LPAs reviewed facility records, including any incident documentation. There was no documentation indicating the incident occurred or that medical attention was sought. LPA interviewed current facility staff that would have been employed during the time the incident occurred. Two out of two staff stated they could not recall any incident where a child had convulsions or provide information regarding the incident. It is unclear if the staff member(s) present at the time of the alleged incident are currently employed at the facility. LPA has found the nature of the child’s behavior is such that there should not have been delay in getting medical treatment for the child.

A deficiency is cited on the subsequent page of this report (LIC809-D) under the California Code of Regulations, Title 22. The facility representative was provided a copy of their Appeal Rights (LIC9058) and the licensee's signature on this form acknowledges receipt of these rights.

Exit interview conducted and report was reviewed with the licensee, Ginette Stephens and Nicole Moran. A notice of site visit was given and must remain posted for 30 days.
Seychelle De Luca
Kyrsten Williams
DATE: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2026
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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Document Has Been Signed on 07/29/2026 09:12 AM - It Cannot Be Edited


Created By: Kyrsten Williams On 07/14/2026 at 12:18 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CREEKSIDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 343624644

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2026
Section Cited
CCR
101226(c)

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101226 Health Related Services (c) The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized representative ... if the nature of the child's illness or injury is such that there should be no delay in getting medical treatment for the child.
This requirement is not me at evidenced by:
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Facility representative will conduct a training regarding emergency medical treatment. Facility representative will submit proof of completion and content to LPA via email by POC due date.
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Based on interview and record review, the licensee did not comply with the section cited above as an infant did not receive medical attention after appearing to have convulsions, which poses/posed an 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.
Seychelle De Luca
NAME OF LICENSING PROGRAM MANAGER:
Kyrsten Williams
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2026


LIC809 (FAS) - (06/04)
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