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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212559
Report Date: 12/11/2025
Date Signed: 12/12/2025 09:17:39 AM

Document Has Been Signed on 12/12/2025 09:17 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LAKESHORE CHILDREN'S CENTERFACILITY NUMBER:
010212559
ADMINISTRATOR/
DIRECTOR:		THOMPSON, RAE RITA FFACILITY TYPE:
840
ADDRESS:3518-3546 LAKESHORE AVENUETELEPHONE:
(510) 893-4048
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 65TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
12/11/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Michelle LeProhnTIME VISIT/
INSPECTION COMPLETED:
04:37 PM
NARRATIVE
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On 12/11/2025 at 3:00 PM, Licensing Program Analyst's (LPA's) Kareeca "Reeca" Sykes and Mone Flores conducted a Case Management Visit at Lakeshore Children's Center. LPA's met with Authorized Facility Representative Michelle LeProhn to Deliver the Findings for an previous Complaint Investigation. During the visit, there were no School Age children in care. Facility Representative informed LPA's that there were currently 45 school aged children enrolled.

During the complaint investigation, LPA's conducted multiple interviews with current staff, former staff, children, and parents. During these interviews, LPA's were informed that a back room in the "green room" area is where school age children would play or use the restroom on a daily basis. LPA's identified this room on the facility sketch, which the facility had requested to put the room ON-LIMITS but was never completed. LPA's informed the Facility Representative that if an area is considered OFF-LIMIT to children in care, and has not been approved as ON LIMIT area children are unable to enter the area. Children having access or in an off limits area, even for a short period of time is in violation of California Code of Regulations, Title 22.

LPA's informed Facility Representative Michelle LeProhn that this report dated 12/11/2025 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care.


See LIC 809-D for deficiency.

Exit interview conducted and report was reviewed with the Facility Representative, Michelle LeProhn. A notice of site visit was given and must remain posted for 30 consecutive days.
NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Kareeca Sykes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 12/12/2025 09:17 AM - It Cannot Be Edited


Created By: Kareeca Sykes On 12/11/2025 at 04:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LAKESHORE CHILDREN'S CENTER
FACILITY NUMBER: 010212559

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2025
Section Cited
CCR
101161(a)

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 Limitations on Capacity. The licensee shall not exceed the conditions, limitations and capacity specified in the license. This requirement was not met as evidenced by observation and interviews with current staff, former staff, children, and parent who confirmed school age children play in an off limits area. LPA identified
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By 12/19/2025 Close of Business, the facility will submit a written statement to LPA, explaining how the facility will remain in compliance. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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.... this room on the facility sketch, which the facility had requested to put the room ON-LIMITS but was never completed which poses an potential risk to the health, safety or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:
Kareeca Sykes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2025


LIC809 (FAS) - (06/04)
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