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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173003241
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:20:06 PM

Document Has Been Signed on 07/10/2024 01:20 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LAKE FAMILY RESOURCE CENTERFACILITY NUMBER:
173003241
ADMINISTRATOR/
DIRECTOR:		REBECCA JOYCEFACILITY TYPE:
830
ADDRESS:896 LAKEPORT BOULEVARDTELEPHONE:
(707) 263-6951
CITY:LAKEPORTSTATE: CAZIP CODE:
95453
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 21DATE:
07/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Rebecca JoyceTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 07/10/2024, Licensing Program Analyst (LPA), Sebastian Phouthaovong made an unannounced Case Management visit to follow up on an Unusual Incident Report (UIR) submitted to CCL on 07/08/2024. LPA met with Site Supervisor, Rebecca Joyce and spoke with her the regarding the UIR in which a child stained an injury.

During today's inspection, LPA toured the facility inside and out and observed 21 children being supervised by 7 staff members. LPA conducted interviews with the Site Supervisor & 3 staff and made observations.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor, Rebecca Joyce.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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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