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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201356
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:26:41 PM

Document Has Been Signed on 08/28/2024 03:26 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:NEEMA HAVEN HOME BAYFACILITY NUMBER:
079201356
ADMINISTRATOR/
DIRECTOR:		GITHII, GEORGE NJUNGEFACILITY TYPE:
735
ADDRESS:1914 MINER AVENUETELEPHONE:
(925) 335-6428
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY: 6CENSUS: 0DATE:
08/28/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Goodluck Ndefungo, Licensee TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 8/28/2024 at 2:45pm, Licensing Program Analyst (LPA) Carol Fowler conducted a second announced pre-licensing visit. LPA met with Goodluck Ndefungo, Licensee, and explained the purpose of the visit. The facility has an approved fire safety clearance for six (6) ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage and back yard. The facility has a total of three (3) bedrooms and two (2) bathrooms There is sufficient lighting around the facility. Clients rooms are equipped with the beds, chairs, dressers, night stands and lighting. Clients rooms have proper bedding and linens. Passageways and hallways are free of obstruction. Hot water temperature is measured at 97.5 degrees Fahrenheit. Fire extinguisher was serviced on 08/26/2024. Smoke detectors/carbon Monoxide detector are equipped around the facility. First aid kit complete.

No Issues were noted during inspection. LPA 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: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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