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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600864
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:56:33 PM

Document Has Been Signed on 12/23/2024 03:56 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LAKEVIEW LODGEFACILITY NUMBER:
415600864
ADMINISTRATOR/
DIRECTOR:		CAMPBELL, ROSALINDAFACILITY TYPE:
740
ADDRESS:530 LAKEVIEW WAYTELEPHONE:
(650) 369-7476
CITY:EMERALD HILLSSTATE: CAZIP CODE:
94062
CAPACITY: 49TOTAL ENROLLED CHILDREN: 0CENSUS: 32DATE:
12/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:52 PM
MET WITH:Zach Pilkerton, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 12/23/2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction (POC) visit for a deficiency cited on 12/12/2024. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit.

LPA Calandra cleared the deficiency and provided a POC clearance letter to Zach Pilkerton, Administrator. \

No deficiencies were cited during today's visit.

An exit interview was conducted and a copy of the report left at the facility.
Andrea MedlinTELEPHONE: (650) 266-8811
John CalandraTELEPHONE: 650-266-8800
DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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