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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405019
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:02:37 PM

Document Has Been Signed on 08/31/2023 12:02 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:CREEK, A MIDDLE SCHOOL YOUTH CENTER, THEFACILITY NUMBER:
073405019
ADMINISTRATOR:PAULINA TORRESFACILITY TYPE:
840
ADDRESS:2775 CEDRO LANETELEPHONE:
(925) 934-3324
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 0DATE:
08/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Paulina TorresTIME COMPLETED:
12:15 PM
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On 8/31/23, Licensing Program Analyst (LPA) Melissa Domantay conducted a case management inspection at this facility. LPA met with Executive Director, Paulina Torres. There were no children present. An application was received with a request for a decrease change of capacity to the license. School Age program will operate in 2 modulars. The facility will operate Monday-Friday 7:00am-6:00pm on the grounds of the Foothill Middle School.

The 2 modulars were toured to conduct a health and safety inspection with Executive Director, Paulina Torres. LPA did not observe any hazardous items, defects or dangerous conditions. There are fully charged fire extinguishers, centralized combination carbon monoxide/smoke detection system, and first aid kit in each modular.

The new school age license is effective 8/31/23 with a capacity of 75 children. There are no deficiencies being cited. An exit interview was conducted with Executive Director, Paulina Torres and appeal rights were provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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