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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
015700019
Report Date:
08/31/2022
Date Signed:
09/14/2022 10:26:01 AM
Document Has Been Signed on
09/14/2022 10:26 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
CCLD Regional Office
,
1515 CLAY STREET STE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
BOGA, PRIYANKA
FACILITY NUMBER:
015700019
ADMINISTRATOR:
BOGA, PRIYANKA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(225) 368-6002
CITY:
PLEASANTON
STATE:
CA
ZIP CODE:
94588
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
11
DATE:
08/31/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Priyanka Boga
TIME COMPLETED:
03:00 PM
NARRATIVE
1
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This report was lost on 8/31/2022 due to computer equipment theft, this is a reproduced report.
(See Attached original report for signatures on page 3.)
SUPERVISORS NAME
:
Chandra Charles
LICENSING EVALUATOR NAME
:
Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/31/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1515 CLAY STREET STE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
BOGA, PRIYANKA
FACILITY NUMBER:
015700019
VISIT DATE:
08/31/2022
NARRATIVE
1
2
3
4
5
6
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32
SUPERVISORS NAME
:
Chandra Charles
LICENSING EVALUATOR NAME
:
Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2022
LIC809
(FAS) - (06/04)
Page:
2
of
3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1515 CLAY STREET STE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
BOGA, PRIYANKA
FACILITY NUMBER:
015700019
VISIT DATE:
08/31/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
28
29
30
31
32
THIS REPORT WAS REPRODUCED DUE TO WORK EQUIPMENT STOLEN. ORIGINAL VISIT/REPORT DATED 8/31/22 WAS NOT REPLICATED
PBFacility-Evalution-report.pdf
SUPERVISORS NAME
:
Chandra Charles
LICENSING EVALUATOR NAME
:
Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2022
LIC809
(FAS) - (06/04)
Page:
3
of
3
