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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423157
Report Date: 04/19/2022
Date Signed: 04/19/2022 02:15:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/19/2022 02:15 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:JONES, KIMBERLYFACILITY NUMBER:
013423157
ADMINISTRATOR:JONES, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 706-3376
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:TIME COMPLETED:
02:21 PM
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LPA Cortez arrived and knocked on the door multiple times and no one answered.

LPA Cortez called the number on file, and licensee stated that they have decided to close for the week due to a family and personal event that came up during the weekend. She is out of town for the whole week. And will be back for next week. Inspection was rescheduled to next week
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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