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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700391
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:24:29 PM

Document Has Been Signed on 01/31/2024 03:24 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HUSEIN, LINAFACILITY NUMBER:
015700391
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
01/31/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Lina HuseinTIME COMPLETED:
02:38 PM
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Licensee requested for the technical assistance from LPA Cortez to check if the 3 other rooms are are within health and safety standards for she plans to place them on limits. And she plans to increase capacity this year.

LPA Cortez provided technical advice and gave consultation to the physical plants modifications needed

Licensee will create modifications and will notify LPA Cortez when done modifying.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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