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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700168
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:57:12 PM

Document Has Been Signed on 05/24/2023 02:57 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
OAKLAND SOUTH EAST, 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: DATE:
05/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Betsy RajTIME COMPLETED:
03:45 PM
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On May 24, 2023 Licensing Program Analyst (LPA) Sidney Cortez conducted a case management visit for an inactive licensee Betsy Raj who wants to re-open by June-July 2023 of this year. She needed guidance and refresher on the forms and health and safety guidelines.

She inquired about the physical plants and the potential renovations that she plans to do. A pre licensing packet was given to Betsy Raj to serve as guide for the forms and ratios and necessary documents that needs to be posted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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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