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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201380
Report Date: 01/29/2025
Date Signed: 01/29/2025 02:46:37 PM

Document Has Been Signed on 01/29/2025 02:46 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:
01/29/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:LJ Jennings Applicant TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 1/29/25 at 1:30 PM, Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived announced to conduct pre-licensing inspection. LPA met with LJ Jennings Applicant and explained the purpose of the visit. The facility currently has no residents.

LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Hot water temperature was maintained at 119 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 06/25/2024

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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