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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201462
Report Date: 02/26/2025
Date Signed: 02/26/2025 10:35:46 AM

Document Has Been Signed on 02/26/2025 10:35 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 ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:K & J RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
019201462
ADMINISTRATOR/
DIRECTOR:		LIANG, KSAIFACILITY TYPE:
740
ADDRESS:2046 CLEMATIS CTTELEPHONE:
(510) 396-5818
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 6CENSUS: 0DATE:
02/26/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Ksai Liang, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:45 PM
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On 02/26/2025 at 8:50 AM, Licensing Program Analysts (LPA) P. Manalo announced to conduct pre licensing inspection. LPAs met with Licensee/Applicant, Ksai Liang and explained the purpose of the visit. The facility has an approved fire clearance for six (6) non-ambulatory.

LPA toured facility with Licensee/applicant including but not limited to 6 bedrooms which 5 bedrooms will be occupied for residents and 1 staff room, 4 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped built in non-skid shower pan. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 58 degrees F and hot water temperature was maintained at 128.3 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 02/26/2025.

The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB):
  • At 10:11 AM, LPA observed hot water was measured at 128.3 degrees Fahrenheit in the hallway bathroom sink.
  • At 10:19 AM, LPA observed that there is no adequate shaded area.

This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted and a copy of this report was provided to Licensee/applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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