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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405625
Report Date: 10/09/2023
Date Signed: 10/09/2023 01:06:04 PM


Document Has Been Signed on 10/09/2023 01:06 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:OLD FIREHOUSE SCHOOL WALNUT CREEKFACILITY NUMBER:
073405625
ADMINISTRATOR:JUDY HAUSFACILITY TYPE:
850
ADDRESS:55 ECKLEY LANETELEPHONE:
(925) 934-1507
CITY:WALNUT CREETSTATE: CAZIP CODE:
94596
CAPACITY:45CENSUS: 39DATE:
10/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Judy HausTIME COMPLETED:
01:30 PM
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On 10/9/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection at Old Firehouse School Walnut Creek and met with Director, Judy Haus.

On 10/6/23 Center reported an incident to Licensing Department about a parent expressing concern that staff allegedly mishandled their child.

During today's inspection, LPA interviewed the Director, children and staff, reviewed files, conducted room observations and obtained documents.

No deficiencies were issued during today's visit. Exit Interview was conducted, where this report was reviewed and discussed with Director, Judy Haus.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2023
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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