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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700168
Report Date: 11/15/2022
Date Signed: 11/15/2022 05:36:25 PM

Document Has Been Signed on 11/15/2022 05:36 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 1102
OAKLAND, CA 94612
FACILITY NAME:RAJ, BETSYFACILITY NUMBER:
015700168
ADMINISTRATOR:RAJ, BETSYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 396-8988
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
11/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:11 PM
MET WITH:Betsy RajTIME COMPLETED:
04:24 PM
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On Nov 15, 2022 Licensing Program Analayst Sidney Cortez conducted a case management visit for Betsy Raj. Present on this visit is the licensee, and 2 pre school age children. Licensee wanted technical advice.


Licensee wanted advice on covid 19 guidelines, and set up of her on limit areas. Licensee wanted advice on current physical plants; and supervision guidelines.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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