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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201380
Report Date: 10/28/2024
Date Signed: 10/28/2024 01:38:03 PM

Document Has Been Signed on 10/28/2024 01:38 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. 310
OAKLAND, CA 94612
FACILITY NAME:KINGDOM BUILDERS TRANSITIONAL HOUSING PROGRAMFACILITY NUMBER:
019201380
ADMINISTRATOR/
DIRECTOR:		JENNINGS, KARENFACILITY TYPE:
772
ADDRESS:7988 SUNKIST DRIVETELEPHONE:
(510) 575-9881
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 6CENSUS: 0DATE:
10/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:LJ Jennings, Licensee TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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***This is an amended copy of report issued on 10/25/2024***

On 10/28/2024 Licensing Program Analyst (LPA) K. Nguyen amended this report for pre-license inspection conducted on 10/25/2024. LPA created document under incorrect facility number. This report should be under facility #019201381. This report was created in error. LPA collected original report and recreated report under correct facility number.



Exit interview conducted with LJ Jennings, Applicant/Licensee and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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