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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406685
Report Date: 08/05/2019
Date Signed: 08/05/2019 12:40:58 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 MIDDLE SCHOOL YOUTH PROGRAM - WCI, THEFACILITY NUMBER:
073406685
ADMINISTRATOR:PAULINA TORRESFACILITY TYPE:
840
ADDRESS:2425 WALNUT BLVDTELEPHONE:
(925) 934-3324
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:75CENSUS: 0DATE:
08/05/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Colleen WhiteTIME COMPLETED:
01:00 PM
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Licensing Program Analyst, R. Hollie, met with Director, Colleen White, for the purpose of a Required Health and Safety Inspection. Today will be the facility's last required visit. The facility will be placed back on Random Inspections. There are no children present today, nor are there staff present. The facility is closed currently for summer, and is due to re-open for the new school year, August 15th.

A tour of the facility was conducted. There are no Zero Tolerance items on the premises, such as bodies of water or fire arms, per the Director. The licensee understands that the facility cannot exceed the licensed capacity. Although no there are no children present, the Director understands that Title 22 Regulations, require children to be supervised at all times. Per Ms. White, children have not been left without supervision.
The facility was reminded that all person's 18 years of age or older, must be fingerprint cleared, obtain current immunization's and complete a mandated reporter training PRIOR to working with day care children.
The Director has current CPR/FA.
PLEASE SEE NEXT PAGE FOR CONTINUED REPORT
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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 MIDDLE SCHOOL YOUTH PROGRAM - WCI, THE
FACILITY NUMBER: 073406685
VISIT DATE: 08/05/2019
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 LPA reviewed a sampling of personnel records which contain health screenings.
The licensee understands that Disinfectants, cleaning solutions, poisons and other items that are dangerous to children, shall be kept out of the reach of children.
Furniture and equipment appear to be in good condition and free of sharp, loose or pointed parts.
Toilets and sinks are working with sufficient soap and paper products.
The kitchen preparation area and storage area is clean and free of litter or the evidence of rodent or other vermin.

The school play yard is used by the center.
The licensee understands that menus are posted at least one week in advance, in a place visible by the child's authorized representative, dated and kept on the file for 30 days and made available upon request.
The facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

A random sampling of children's records was reviewed during this visit.
THERE ARE NO DEFICIENCIES CITED DURING THIS VISIT.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
LIC809 (FAS) - (06/04)
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