<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201462
Report Date: 02/27/2025
Date Signed: 02/27/2025 10:39:25 AM

Document Has Been Signed on 02/27/2025 10:39 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:
02/27/2025
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Ksai Liang, Licensee/ Applicant TIME VISIT/
INSPECTION COMPLETED:
10:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/27/2025 at 10:20 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived announced to conduct Component lll with Licensee/applicant Ksai Liang.

LPAs went over with Licensee/ applicant Component lll Power point presentation. LPAs provided applicant with CCLD and LPA contact information.

A copy of this report was provided to applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1