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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405019
Report Date: 09/27/2021
Date Signed: 09/27/2021 12:56:04 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:CREEK, A MIDDLE SCHOOL YOUTH CENTER, THEFACILITY NUMBER:
073405019
ADMINISTRATOR:PAULINA TORRESFACILITY TYPE:
840
ADDRESS:2775 CEDRO LANETELEPHONE:
(925) 934-3324
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:100CENSUS: 0DATE:
09/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Paulina TorresTIME COMPLETED:
01:15 PM
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On 9/27/21 at 12:30 pm Licensing Program Analyst (LPA) Monica Mathur conducted a case management inspection at the center and met with Exec Director, Paulina Torres. There were no children present during the visit.

The purpose of the inspection is to review the amended report, originally dated 8/23/21. LPA reviewed the report with Paulina Torres.

There are no deficiencies being cited today. This report will remain on file for 3 years. An exit interview was conducted. Notice of Site Visit and appeal rights were provided.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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