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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214193
Report Date: 06/07/2021
Date Signed: 06/07/2021 05:25:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LAKEMAN FCC AKA LITTLE FINGERS AND TOESFACILITY NUMBER:
406214193
ADMINISTRATOR:LAKEMAN, LEENTJEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 382-9275
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 6DATE:
06/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:09 PM
MET WITH:Valeria GillTIME COMPLETED:
05:30 PM
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On 6/7/2021 at 4:09pm, Licensing Program Analyst (LPA) Melissa Stewart arrived at Family Child Care Home (FCCH) and called the number on record which went straight to voicemail. LPA knocked on the door and was greeted by Assistant, Valeria Gil who reported that Licensee, Leentje Lakeman was not present at the home. LPA conducted a Risk Assessment for COVID19 prior to entering the FCCH. LPA explained the purpose of the visit was to follow up regarding the Unusual Incident which was alleged to have occurred on 4/20/21 and was self-reported by Licensee on 4/23/21. There were six (6) children present at time of inspection.

LPA interviewed Assistant regarding the incident in which C1 reported to C1s parent that C1 had been touched between the legs in a private area by C2 while sitting on the couch watching a video. LPA also interviewed two (2) children. Due to Licensee not being present at this time, LPA will return to complete the follow up.

An exit interview was conducted and copy of this report and appeal rights were discussed and left with Assistant, Valeria Gil, whose signature on this form confirm receipt of these documents.

No deficiencies cited today. LPA observed the Notice of Site Visit posted.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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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