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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008959
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:06:17 PM

Document Has Been Signed on 03/06/2025 01:06 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LANCASTER, TASHENA FCCHFACILITY NUMBER:
483008959
ADMINISTRATOR/
DIRECTOR:
LANCASTER, TASHENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 731-0257
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:47 PM
MET WITH:Not availableTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA), Cindy Castro made an unannounced Case Management inspection to the facility to verify operation at the facility, and to address the facility's forfeiture due to expired inactive status and non-payment of fees. Prior to today’s inspection, contact was made with licensee on 01/07/25, regarding expired inactive status and past due fees and information and forms were provided to be updated/submitted to department with a due date of 01/10/25.

Upon arrival on 03/06/25, LPA did not observe evidence of operation and/or childcare being provided at the facility. LPA rang doorbell twice and knocked on front door twice a male individual answered on ring voice and stated that his wife was not home. LPA left business card on front door. LPA did not hear or observe any children in care.

The approval for the closure/forfeiture of license has been met.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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