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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406685
Report Date: 08/04/2022
Date Signed: 08/04/2022 10:52:13 AM


Document Has Been Signed on 08/04/2022 10:52 AM - 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:CREEK MIDDLE SCHOOL YOUTH PROGRAM - WCI, THEFACILITY NUMBER:
073406685
ADMINISTRATOR:ALMA REYES GUZMANFACILITY TYPE:
840
ADDRESS:2425 WALNUT BLVDTELEPHONE:
(925) 746-5536
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:75CENSUS: 0DATE:
08/04/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:ALMA REYES GUZMANTIME COMPLETED:
11:15 AM
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On 8/4/22 at 10:00am, Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit conducted a case management inspection at this facility. LPAs met with Alma Reyes, Site Director. There were no children present. An application was received with a request to add a room to the license, Room 704. The facility will operate Monday-Friday 3:00pm-6pm on the grounds of the Walnut Creek Intermediate School.

A tour of the Room #704 was conducted for a health and safety inspection with Site Director Alma. LPAs 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 Room #704 can be used by the child care facility was received from Site Director Alma. A fire clearance, dated 7/22/22, was received from the Contra Costa County Fire Protection Department.

Room #704 will be added to the school age license effective 8/4/22 with a capacity of 61 children. There are no deficiencies being cited. An exit interview was conducted with Site Director Alma 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: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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