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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405692
Report Date: 08/09/2022
Date Signed: 08/09/2022 02:55:59 PM


Document Has Been Signed on 08/09/2022 02:55 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:SRVSACCA-CREEKSIDEFACILITY NUMBER:
073405692
ADMINISTRATOR:SAMS, DANIFACILITY TYPE:
840
ADDRESS:6055 MASSARA STTELEPHONE:
(925) 743-3170
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY:188CENSUS: 33DATE:
08/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Aniano Garcia and Ann TanciocoTIME COMPLETED:
03:30 PM
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On 8/9/22 at 1:15pm, Licensing Program Analyst (LPA) Melissa Domantay conducted a case management inspection at this facility. LPA met with Aniano "Ian" Garcia, Site Director and Executive Director Ann Tancioco. There are 33 children present. An application was received with a request to add a room to the license, Room# B215. The facility will operate Monday-Friday 6:30am-6:30pm on the grounds of Creekside Elementary School.

A tour of the Room# B215 was conducted for a health and safety inspection with Site Director Ian and Executive Director Ann. LPA did not observe any hazardous items, defects or dangerous conditions. The entrance area of the room has a fully charged 2A10BC fire extinguisher and centralized combination carbon monoxide/smoke detection system. An updated superintendent's certification, indicating that school-age classroom(s) can be used by the child care facility was received from applicant. The facility is pending a fire clearance. The facility has provided the San Ramon Valley Fire Protection District Fire & Life Safety Division Inspection Compliance Report, dated 2/16/2022 for Creekside Elementary.

Room# B215 will be added to the school age license effective 8/9/22 with a capacity of 188 children. There are no deficiencies being cited. An exit interview was conducted with Site Director Ian and Executive Director Ann and appeal rights were provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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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