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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405692
Report Date: 02/27/2024
Date Signed: 02/27/2024 11:33:20 AM

Document Has Been Signed on 02/27/2024 11:33 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
OAKLAND CC RO, 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: DATE:
02/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Ian GarciaTIME COMPLETED:
11:45 AM
NARRATIVE
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On 2/27/2024 at 11:20am Licensing Program Analyst (LPA) arrived at Creekside Elementary School: San Ramon Valley Kid's Country to conduct a Plan of Correction visit. LPA was met by site director Ian Garcia. There were no children present during the inspection. However, the site director advises 95 students are currently enrolled.

On 12/21/2023 the facility was cited for personal rights due to a complaint that was received by licensing.

The facility was required to review personal rights video via CDSS website and submit answers to the subsequent questions.

Per today's visit the facility has completed the required Plan of Correction as of 2/9/2024.

LPA collected documentation of Plan of Correction from site director Ian Garcia.

Based upon observation there were no deficiencies cited today.

Exit interview conducted with site director Ian Garcia. Appeal rights were provided and a notice of site visit was provided to be posted for 30 consecutive days.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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