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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406054
Report Date: 05/05/2023
Date Signed: 05/05/2023 04:25:14 PM


Document Has Been Signed on 05/05/2023 04:25 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:KLEYMAN, LANAFACILITY NUMBER:
073406054
ADMINISTRATOR:KLEYMAN, LANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 363-3535
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:14CENSUS: 0DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:LICENSEE'S SONTIME COMPLETED:
12:15 PM
NARRATIVE
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH A GENTLEMAN WHO IDENTIFIED HIMSELF AS THE LICENSEE'S SON. PER LICENSEE'S SON, MRS. KLEYMAN IS NOT HOME TODAY. THERE ARE NO CHILDREN PRESENT IN THE HOME, PER THE SON, THE LICENSEE IS NO LONGER CARING FOR CHILDREN AND HAS PERMANENTLY CLOSED HER FAMILY CHILD CARE HOME. IT IS NOT KNOWN HOW LONG THE FACILITY HAS BEEN CLOSED. LPA GAVE THE GENTLEMAN A BUSINESS CARD AND ASKED THAT HE HAVE THE LICENSEE CALL THIS LPA TO GIVE AN UPDATE ON HER FACILITY STATUS. LPA WILL WAIT UNTIL WE RECEIVE CONFIRMATION FROM LICENSEE OF THE CLOSURE OF HER FACILITY BEFORE CLOSING THE FACILITY FILE.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023
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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