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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405685
Report Date: 09/01/2023
Date Signed: 09/01/2023 12:04:29 PM

Document Has Been Signed on 09/01/2023 12:04 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:HAPPY LION DAY CARE CENTERFACILITY NUMBER:
073405685
ADMINISTRATOR:CHAVIS, WEDNESDAYFACILITY TYPE:
850
ADDRESS:2929 CASTRO ROADTELEPHONE:
(510) 734-9119
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY: 29TOTAL ENROLLED CHILDREN: 29CENSUS: DATE:
09/01/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Wednesday ChavisTIME COMPLETED:
12:10 PM
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On September 1, 2023 at 11:21am Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPM) Mayla Mendoza arrived at the facility for the purpose of conducting interviews regarding a complaint at another facility.

Exit Interview conducted and report provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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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