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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600545
Report Date: 02/13/2024
Date Signed: 02/15/2024 08:51:02 AM

Document Has Been Signed on 02/15/2024 08:51 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ITHACA HOMEFACILITY NUMBER:
015600545
ADMINISTRATOR:DE LEON, VICTORFACILITY TYPE:
735
ADDRESS:32295 ITHACA STREETTELEPHONE:
(510) 400-3168
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 6CENSUS: 4DATE:
02/13/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Victor de Leon, Licensee/AdministratorTIME COMPLETED:
04:00 PM
NARRATIVE
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On 02/13/2024 starting at 3:00PM, an informal meeting was held via video conference with Licensees, Victor and Imelda de Leon. The purpose of this informal meeting was to discuss the deficiencies that were issued during the Complaint visit on 01/11/2024 and the suspension of business license. The informal conference process was explained to the Licensees.

Attendees:
  • Victor de Leon, Licensee/Administrator
  • Imelda de Leon, Licensee
  • Maureen de Leon, Co-Administrator
  • Yvonne Flores-Larios, Licensing Program Manager
  • Jeremy Fong, Licensing Program Manager
  • Luisa Fontanilla, Licensing Program Analyst
  • Lori Alexander, Licensing Program Analyst

Issues discussed during the meeting:
  • Instructions from the Franchise Tax Board to rectify non-filing of taxes since 2020.
  • The Business license has been suspended with the Secretary of State due to non-filing of taxes.

    • 1.

LIC809 Continued....
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ITHACA HOME
FACILITY NUMBER: 015600545
VISIT DATE: 02/13/2024
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LIC 809C Continued....
  • The Department was informed that the Licensees received a foreclosure notice, and Mr. de Leon provided documents indicating that the minimum due to reinstate the mortgage was requested with the financial institutions.

  • Licensees Victor de Leon and Imelda de Leon were informed that the current Licensee is De Leon Enterprises, INC., that they both make up the LLC, and remain responsible for addressing the reinstating of the LLC with the Secretary of State.
  • The Licensees agreed to submit a detailed and acceptable plan describing what steps need to be taken to reinstate the current business entity under the Secretary of State, by February 23, 2024.

Exit interview conducted and a copy of this report provided to Licensee via Email.


LIC 809 Informal Meeting Report - Signed 02.15.2024.pdfLIC 809 Informal Meeting Report - Signed 02.15.2024.pdf


SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
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