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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411363
Report Date: 08/26/2024
Date Signed: 08/26/2024 10:21:39 AM

Document Has Been Signed on 08/26/2024 10:21 AM - 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:BROWN, SENOVIAFACILITY NUMBER:
013411363
ADMINISTRATOR/
DIRECTOR:		BROWN, SENOVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 567-6188
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Senovia BrownTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst Elimika Woods conducted a case management visit for Senovia Brown. LPA Woods was initially going to conduct an Annual Random inspection but the licensee said that she has not been operational since August 19, 2024. She does not have any children and wishes to go inactive.

LPA Woods provided licensee the form LIC 9211 to go inactive status.

Licensee was reminded that the inactive status is an annual time frame basis, and that if she wishes to continue stay inactive she will need to notify RO and send another LIC 9211.

Facility is on inactive status effective 08/26/2024. Inactive status expires on 02/26/2025.

This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. Exit interview was conducted and reviewed with the licensee, Senovia Brown..

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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