073408957-6-16-2023-02-CC-MDOY-CSUQ9S-20230616115848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408957
Report Date: 06/16/2023
Date Signed: 06/16/2023 11:59:07 AM

Document Has Been Signed on 06/16/2023 11:59 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, A MIDDLE SCHOOL YOUTH CENTER, THE		FACILITY NUMBER:	073408957
ADMINISTRATOR:	ALMA REYES		FACILITY TYPE:	840
ADDRESS:	2730 MITCHELL DRIVE		TELEPHONE:	(925) 934-3324
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 0	DATE:	06/16/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Paulina Torres		TIME COMPLETED:	12:10 PM

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 6/16/23, Licensing Program Analyst (LPA) Melissa Domantay conducted a Prelicensing inspection today, for the new application for a school-age program. LPA met with Applicant Paulina Torres and toured all areas of the facility for a health and safety inspection. There were no school-age children present during the inspection. The hours of operation are Monday through Friday from 7:00am to 6:00pm. The facility will operate on the school grounds of Contra Costa School of Performing Arts a Public Charter School. A fire clearance, with a total capacity of (48) school-age children 10 years to 18 years for a total capacity of 48 was received from the Contra Costa County Fire Protection Department, dated 5/25/2023. LPA observed that the school-age classrooms has sufficient lighting and appears to be clean and in good condition. LPA observed an ample supply of age appropriate activities, equipment and furniture. The school-age program operates in 2 designated classrooms, Classroom #121 and Classroom #124. Applicant Paulina provided signed Superintendent's/ Executive Director's Certification for approval to operate on the school grounds of Contra Costa School of Performing Arts a Public Charter School. The facility has a separate bathroom for boys and girls. The facility has a total of 3 sinks, 4 toilets, and 2 urinals in the boys bathroom and 3 sinks and 6 toilets in the girls bathroom available for school-age children to utilize at the facility. The building has two fully charged fire extinguishers, working fire alarm and carbon monoxide detector, and first aid supplies. There is a working telephone at the center. LPA did not observe any hazardous items that would be accessible to children. There is a kitchen on site. Facility will provide water for children, with water still accessible to children inside and outside. Facility will provide PM snacks. Facility will utilize manual and electronic sign in/out. See 809-C for continuance.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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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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: CREEK, A MIDDLE SCHOOL YOUTH CENTER, THE	FACILITY NUMBER: 073408957
	VISIT DATE: 06/16/2023

NARRATIVE

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LPA observed the outdoor patio area outside of Room #124. LPA observed ample amount of shade for children. Per LPM Mendoza, school age program is exempt from outdoor fencing due to operation on school grounds. The facility will not provide transportation for children.

The isolation area will be Classroom #121.

Alma is considered a qualified Director with current CPR/First Aid which expires 8/9/2024 and mandated reporter training's completed.

If this facility plans to provide Incidental Medical Services – IMS. A Plan of Operation that includes IMS must be submitted to the Department. 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. LPAs reviewed responses and provided technical assistance including postings. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

A school-age license for a capacity of 48 children will be granted today, 6/16/23. There are no deficiencies being cited today. Exit interview conducted with Applicant Paulina Torres.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

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