073405019-6-8-2023-02-CC-MMAR-CSLUWA-20230608155626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405019
Report Date: 06/08/2023
Date Signed: 06/08/2023 03:56:30 PM

Document Has Been Signed on 06/08/2023 03:56 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CREEK, A MIDDLE SCHOOL YOUTH CENTER, THE		FACILITY NUMBER:	073405019
ADMINISTRATOR:	PAULINA TORRES		FACILITY TYPE:	840
ADDRESS:	2775 CEDRO LANE		TELEPHONE:	(925) 934-3324
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	100	CENSUS: 22	DATE:	06/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Paulina Torres		TIME COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/8/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Required inspection at Creek, A Middle School Youth Center located in the premises of Foothill Middle School. LPA met with Executive Director, Paulina Torres and explained the purpose of today's inspection. Facility is conducting Summer Camp at present, operating days/hours are Monday - Friday from 8am-4:30pm in 2 Rooms - Main Room & Homework Room. The physical plant was inspected and LPA toured premises with the Director. Indoor space: The classrooms, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons, medications, cabinets, drawers and rooms used for storage were locked or inaccessible. Furniture and equipment were age appropriate and in good condition. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Observed a pet guinea pig and gecko in their enclosed cages. Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. Surface of the outdoor activity space was in safe condition and free of hazards. There were no bodies of water observed. Drinking water is readily available to children during indoor and outdoor activities. File Review: Children sign in and out is through electronic system Procare. All children were signed in compliance with the school age sign in/out procedures. A sample of children and staff files was taken for review. There was at least one staff present with current certification in Pediatric CPR and First Aid at the facility during inspection. Children's Roster LIC 9040 and Personnel Report LIC500 was reviewed. Last Fire Drill was conducted in April 2023.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CREEK, A MIDDLE SCHOOL YOUTH CENTER, THE	FACILITY NUMBER: 073405019
	VISIT DATE: 06/08/2023

NARRATIVE

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At present, facility does not have any children enrolled who require Incidental Medical Services (IMS). Policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, no regulatory violations were observed. Exit interview conducted and report was reviewed with the Executive Director, Paulina Torres. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

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