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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700257
Report Date: 09/22/2022
Date Signed: 09/22/2022 02:37:03 PM

Document Has Been Signed on 09/22/2022 02:37 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LANKE, ROHINIFACILITY NUMBER:
015700257
ADMINISTRATOR:LANKE, ROHINIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 279-8418
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/22/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Rohini LankeTIME COMPLETED:
03:00 PM
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On September 22, 2022 LPA Dacanay Breaux returned for Case Management Annual Continuation due to deficiencies cited on September 21, 2022. LPA was granted entry by Licensee. LPA Breaux met with Licensee, Rohini Lanke. During today's inspection there were five (5) children in care.

LPA Breaux discussed both Type A violations:1) Out of Ratio 2) Facility had "baby" items that not permitted in facilities. LPA provided Licensee with the LIC9224 and informed licensee to inform current parents and new parents of the citation using the LIC9224 for up to 12 months, verifying receipt with signature and date, this should remain on file.

LPA Breaux discussed and provided the required forms for files both children and facility (staff).

Notice of site visit provided. Appeal right provided. Exit interview contacted with Licensee, Rohini Lanke.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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