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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406685
Report Date: 08/10/2020
Date Signed: 10/21/2020 04:48:07 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:
08/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Paulina TorresTIME COMPLETED:
12:00 PM
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On 8/10/20 at 11:15am, Licensing Program Analyst (LPA) Loretta Dyson conducted a case management tele-inspection at this facility. A tele inspection was done thru the Zoom application due to the COVID-19 pandemic. LPA met with Paulina Torres, Executive Director. There were no children present. An application was received with a request to add the multi-purpose room to the license. The facility will operate Monday-Friday 7am-6pm on the grounds of the Walnut Creek Intermediate School.

A tour of the multi-purpose room and adjacent bathrooms was conducted with Ms. Torres pointing the camera around so LPA could observe the spaces. Ms. Torres advised that the tables and chairs will be used by children during distance learning. LPA did not observe any hazardous items, defects or dangerous conditions. The entrance area of the room has a fully charged fire extinguisher and centralized combination carbon monoxide/smoke detection system. An updated superintendent's certification, indicating that the multi-purpose room can be used by the child care was received. A fire clearance, dated 8/6/20, was received from the Contra Costa County Fire Protection Department.

The multi-purpose room will be added to the school age license effective 8/10/20. This report will remain on file for 3 years. There are no deficiencies being cited. An electronic signature will not be obtained from the licensee, but the report will be mailed to the licensee for signature.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020
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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