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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406685
Report Date: 08/31/2023
Date Signed: 08/31/2023 11:04:27 AM

Document Has Been Signed on 08/31/2023 11:04 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: 136TOTAL ENROLLED CHILDREN: 136CENSUS: 0DATE:
08/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alma ReyesTIME COMPLETED:
10:50 AM
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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 Alma Reyes, Site Director. There were no children present. An application was received with a request for a decrease change of capacity and adding a room to the license. School Age program will operate in Room 501, 502, 505, 704, and cafeteria. The facility will operate Monday-Friday 7:00am-6pm on the grounds of the Walnut Creek Intermediate School.

Room 501, 502, 505, 704, and cafeteria were toured to conduct a health and safety inspection with Site Director, Alma. LPA did not observe any hazardous items, defects or dangerous conditions. There are fully charged fire extinguishers and centralized combination carbon monoxide/smoke detection system in each room. An updated superintendent's certification, indicating all areas can be used by the child care facility was received from Site Director Alma. A fire clearance for 75 school age children ages, 4.9 to 14 years, was received from the Contra Costa County Fire Protection Department, dated 8/15/23.

Room 501, 502, 505, 704, and cafeteria will be added to the school age license effective 8/31/23 with a capacity of 75 children. There are no deficiencies being cited. An exit interview was conducted with Site Director, Alma 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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