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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
075601431
Report Date:
12/04/2024
Date Signed:
12/04/2024 03:41:54 PM
Document Has Been Signed on
12/04/2024 03:41 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
OAKLAND ASC
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
WALNUT CREEK WILLOWS
FACILITY NUMBER:
075601431
ADMINISTRATOR/
DIRECTOR:
CORTES, ELIZABETH
FACILITY TYPE:
740
ADDRESS:
2015 MT. DIABLO BLVD.
TELEPHONE:
(925) 256-8708
CITY:
WALNUT CREEK
STATE:
CA
ZIP CODE:
94596
CAPACITY:
72
CENSUS:
50
DATE:
12/04/2024
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:
Elizabeth Cortes
TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vincent Moleski and Auditor Preston Saitta arrived unannounced to conduct a collateral visit. LPA Moleski and Auditor Saitta met with facility administrator Elizabeth Cortes and explained the purpose of the visit.
Auditor Saitta and LPA Moleski interviewed a staff member (S1) during this visit.
No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Cortes.
SUPERVISORS NAME
:
Stephen Richardson
LICENSING EVALUATOR NAME
:
Vincent Moleski
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/04/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/04/2024
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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