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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700577
Report Date: 09/28/2023
Date Signed: 09/28/2023 09:58:48 AM

Document Has Been Signed on 09/28/2023 09:58 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:KULASIS, LLC DBA LIVERMORE VALLEY ACADEMYFACILITY NUMBER:
015700577
ADMINISTRATOR:KULALY, FERISHTAFACILITY TYPE:
840
ADDRESS:557 OLIVINA AVENUE, BLDG. BTELEPHONE:
(925) 961-7812
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carol Prince-HunterTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced for a Case Management inspection. LPA met with Admissions representative, Carol Prince-Hunter.

The purpose of LPAs visit was to attempt to reach applicant, Ferishta Kulaly. Applicant was currently off-site gathering items for the school. Applicant is not able to return to the facility for another hour. LPA handed facility representative, Carol Prince-Hunter LPA's business card. LPA also provided facility representative with Notice of Incomplete Application letter. LPA is requesting a return phone call within 24 hours or another visit will need to be conducted.

Exit interview conducted with Facility Representative, Carol Prince-Hunter.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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