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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600608
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:44:25 PM

Document Has Been Signed on 02/20/2025 03:44 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, 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:
02/20/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Shirley BordonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On this day at around 3pm, LPA Luisa Fontanilla conducted a case management visit related to the designation of an interim Administrator for Bordon Homes and Bordon Home IV.

During the visit, Licensee/Administrator Shirley Bordon states that these two facilities will have an interim Administrator to replace current Administrator Antonio Bordon who is unable to function the roles of Administrator temporarily.

During the visit, Licensee/Administrator made a phone call and obtained confirmation from Betsy Terrado who accepted the position as Administrator for Bordon Homes and Bordon Home IV.

Licensee/Administrator will send to CCL documents such as Lic 501, Administrator certificate, First aid/CPR and letter by 2/2/82025.

A copy of this report was provided to Bordon.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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