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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201160
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:55:23 PM

Document Has Been Signed on 05/25/2022 02:55 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:REAMER RESIDENCEFACILITY NUMBER:
019201160
ADMINISTRATOR:LAKANDULA, IRENALDFACILITY TYPE:
735
ADDRESS:18039 REAMER ROADTELEPHONE:
(510) 674-9229
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 4CENSUS: 4DATE:
05/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Irenal Lakandula, AdministratorTIME COMPLETED:
03:05 PM
NARRATIVE
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On 5/25/2022 starting at 2:30 PM, Licensing Program Analysts (LPAs) K. Nguyen and L. Francisco conducted a face to face Component III presentation. LPAs conducted Component III with Administrator, Irenal Lakandula.

LPAs presented Component III power point and discussed the regulations embodied in the power point. LPAs observed participant gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conducted and a copy of report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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