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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 02:45:53 PM
Document Has Been Signed on
01/29/2025 02:45 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 PROGRAM
FACILITY NUMBER:
019201380
ADMINISTRATOR/
DIRECTOR:
JENNINGS, KAREN
FACILITY TYPE:
772
ADDRESS:
7988 SUNKIST DRIVE
TELEPHONE:
(510) 575-9881
CITY:
OAKLAND
STATE:
CA
ZIP CODE:
94605
CAPACITY:
6
CENSUS:
DATE:
01/29/2025
TYPE OF VISIT:
Case Management - Other
ANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:
LJ Jennings Applicant
TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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LPAs Greg Clark and Ardalan Gharachorloo conducted a face to face Component III presentation on 1/29/2025 starting at 2:33 pm. LPAs met with licensee and LJ Jennings Applicant.
LPAs presented Component III power point and discussed the regulations embodied in the power point. LPAs observed the participants gained knowledge about running and maintaining the facility in accordance with regulations.
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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