<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405692
Report Date: 09/08/2022
Date Signed: 09/08/2022 10:16:47 AM

Document Has Been Signed on 09/08/2022 10:16 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:SRVSACCA-CREEKSIDEFACILITY NUMBER:
073405692
ADMINISTRATOR:SAMS, DANIFACILITY TYPE:
840
ADDRESS:6055 MASSARA STTELEPHONE:
(925) 743-3170
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY: 188TOTAL ENROLLED CHILDREN: 188CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Aniano GarciaTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/8/22 Licensing Program Analyst (LPA) Monica Mathur conduced an unannounced annual inspection at SRVSACCA Creekside school age program. LPA met with Site Director, Aniano (Ian) Garcia and explained the purpose of today's inspection. There were no children present during the inspection. Facility is located in the premises of Creekside Elementary School. Main facility is closed for maintenance work due to recent water damage. Currently program is operating in the premises of Creekside Elementary School in Rooms B215, K3, K4 which are licensed by CCLD. Hours of operation from 6:30 am - 6:30 pm Monday - Friday.

LPA toured the premises with the Director.
Indoor space: The classrooms, restrooms were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors, fire pull stations, and sprinkler system. All toilets, hand washing areas were observed to be in safe and sanitary operating condition. All materials and surfaces accessible to children appeared to be toxic free.

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Surface of the outdoor activity space was in safe condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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: SRVSACCA-CREEKSIDE
FACILITY NUMBER: 073405692
VISIT DATE: 09/08/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
File Review: A sample of Children and Staff files was taken for review. All files contained required documents. There was at least one staff present with current certification in Pediatric CPR and First Aid at the facility during inspection. Children's Roster LIC 9040 and Personnel Report LIC500 was reviewed. Last Fire Drill was conducted within 6 months.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Reminder: Lead testing should be conducted and submitted before January 2023.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, no regulatory violations were observed.
Exit interview conducted and report was reviewed with the Director, Ian Garcia. A Notice of Site Visit was given and must remain posted for 30 days
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2