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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423117
Report Date: 10/16/2023
Date Signed: 10/16/2023 12:01:29 PM

Document Has Been Signed on 10/16/2023 12:01 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BOULEVARD ACADEMYFACILITY NUMBER:
013423117
ADMINISTRATOR:LI, WAN BINGFACILITY TYPE:
850
ADDRESS:468 BOULEVARD WAYTELEPHONE:
(510) 832-0132
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
10/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Wan Bing LiTIME COMPLETED:
12:15 PM
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On 10/16/2020 at 11:30AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced plan of correction visit. LPA met with the Director, Wang Bing Li, to explain the purpose of today's visit. LPA toured the facility and reviewed relevant documentation. No deficiencies are being cited today.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Wang Bing Li.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2023
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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