<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173008693
Report Date: 04/09/2024
Date Signed: 04/09/2024 11:06:34 AM


Document Has Been Signed on 04/09/2024 11:06 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:EAST LAKE EARLY CONNECTIONFACILITY NUMBER:
173008693
ADMINISTRATOR:RALLS, JESSIEFACILITY TYPE:
850
ADDRESS:13050 HIGH VALLEY ROADTELEPHONE:
(707) 549-3148
CITY:CLEARLAKE OAKSSTATE: CAZIP CODE:
95423
CAPACITY:24CENSUS: 13DATE:
04/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Christina StrickinTIME COMPLETED:
11:15 AM
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 04/09/2023, 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 03/27/2024. LPA met with Site Supervisor, Christina Stricklin 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 13 children being supervised by 2 staff members. LPA conducted interviews with the Director & 1 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 facility representative, Christina Stricklin

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

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1