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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408331
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:36:25 PM

Document Has Been Signed on 05/01/2024 12:36 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:TSEYANG, KUNGAFACILITY NUMBER:
073408331
ADMINISTRATOR/
DIRECTOR:		TSEYANG, KUNGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 367-4252
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
05/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Kunga TseyangTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 5/1/2024, at 11:30AM, Licensing Program Analyst (LPA) Brittany Crass, arrived at the home for an unannounced visit to follow up on deficiencies that were cited on 4/18/2024. LPA met with the licensee, Kunga Tseyang to explain the purpose of the visit.
No deficiencies are being cited today.

Exit interview conducted with the licensee, Kunga Tseyang. Appeal rights were given. Notice of site visit was given and must remain posted for 30 days. Report reviewed with licensee.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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