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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200989
Report Date: 07/13/2020
Date Signed: 07/13/2020 03:36:02 PM

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:ZANNAT BOARDING CARE, INCFACILITY NUMBER:
079200989
ADMINISTRATOR:KAUR, NAVDEEPFACILITY TYPE:
740
ADDRESS:5257 MOHICAN WAYTELEPHONE:
(510) 932-6827
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 0DATE:
07/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Navdeep Kaur and Navjinder Kaur, LincenseesTIME COMPLETED:
03:40 PM
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On 07/13/2020 at 3:10pm, Licensing Program Analyst (LPA), LPA L. Hall conducted a tele-visit Component III presentation.. LPA met with licensees, Navdeep and Navjinder Kaur.

LPA presented Component III power point that was emailed to Licensee before the tele-visit. LPA discussed the regulations embodied in the power point. LPA observed the two participants gained knowledge about running and maintaining the facility in accordance with regulations and answered any questions inquired.

Exit interview conducted with Licensees and a copy provided by email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020
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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