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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 03:27:12 PM

Document Has Been Signed on 08/28/2024 03:27 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Goodluck Ndefungo, Licensee TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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An announced Pre-licensing Comp III associated with Pre-Licensing Inspection done on 8/28/2024 at 3:30pm was conducted by Licensing Program Analyst (LPA) Carol Fowler. Comp III was attended by Goodluck Ndefungo, Licensee.

LPA discussed the power point after which LPA observed Licensee Goodluck Ndefungo with a better and clear understanding of Title 22 regulations and Community Care Licensing in general.

LPA concluded Comp III.

No citation made during this visit. 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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