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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600608
Report Date: 01/23/2025
Date Signed: 01/23/2025 03:04:05 PM

Document Has Been Signed on 01/23/2025 03:04 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BORDON HOMESFACILITY NUMBER:
015600608
ADMINISTRATOR/
DIRECTOR:		BORDON, SHIRLEYFACILITY TYPE:
735
ADDRESS:4505 DARCELLE DRIVETELEPHONE:
(510) 487-3627
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 3DATE:
01/23/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:43 PM
MET WITH:May Angelica Ignacio, Direct Care StaffTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 01/23/2025 at 2:43 PM, Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla arrived unannounced to amend report previously issued on 01/09/2025. LPAs met with Care Staff, May Angelica Ignacio and explained the purpose of the visit.

LPAs amended report (LIC9099) previously issued on 01/09/2025. LPAs printed the amended reports and provided a copy.


Exit interview conducted. A copy of the reports was provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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