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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008959
Report Date: 11/01/2023
Date Signed: 11/01/2023 10:16:43 AM

Document Has Been Signed on 11/01/2023 10:16 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LANCASTER, TASHENA FCCHFACILITY NUMBER:
483008959
ADMINISTRATOR:LANCASTER, TASHENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 731-0257
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
10:15 AM
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On 11/01/23 at 10:00am, LPA, Castro made an attempted unannounced visit to the facility. LPA rang doorbell and knocked at facility front entry door, however; there was no response at the door. LPA observed a black Lexus was parked in the facility driveway. LPA made an attempted telephone call and left a voice message to address the facility's forfeiture due to unpaid licensing fees. Prior to visit, on 10/27/23 LPA attempted a call with Licensee and left a voicemail. LPA left a business card with a copy of the Forfeiture of Closure letter on the front entry door.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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