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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401122
Report Date: 09/04/2019
Date Signed: 09/04/2019 03:28:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:WALNUT HEIGHTS KID'S CLUB INC.FACILITY NUMBER:
073401122
ADMINISTRATOR:PASSAGLIA, ANNETTEFACILITY TYPE:
840
ADDRESS:4064 WALNUT BOULEVARDTELEPHONE:
(925) 930-8458
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:120CENSUS: 117DATE:
09/04/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Annette PassagliaTIME COMPLETED:
03:45 PM
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A Case Management inspection was conducted on this date by Licensing Program Manager (LPM) Wynn Norona. LPM met with Executive Director, Annette Passaglia. The center has applied for an increase of capacity from 120 to 150 school-age children. The program is operating in Kid's Club Building (Room 20 and Room 20A) and Multi-Purpose Room inside Walnut Heights Elementary School. There are 117 children with 11 staff present during the tour. A health and safety inspection was conducted inside and outside and the measurements are as follows:

INDOORS: EXEMPT
OUTDOORS: EXEMPT

The center has obtained an approved fire clearance from Contra Costa County Fire Department on 8/22/19. The center was found to be clean, safe, sanitary and in good repair. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. LPM provided a copy of the appeal rights and the signature on this form acknowledges receipt of these right. An exit interview was conducted with Executive Director, Annette Passaglia.

Effective today, September 4, 2019, a license has been approved for 150 school-age children.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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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