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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200543
Report Date: 12/18/2024
Date Signed: 12/18/2024 02:26:30 PM

Document Has Been Signed on 12/18/2024 02:26 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:WORTHY HOUSE #1FACILITY NUMBER:
019200543
ADMINISTRATOR/
DIRECTOR:		DAPHNA GARCIAFACILITY TYPE:
735
ADDRESS:568 MEEK AVENUETELEPHONE:
(510) 583-1160
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 2DATE:
12/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Daphna Garcia/AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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While at the facility for other reason, Licensing Program Analyst (LPA) Delmundo observed the following:

1) Construction in progress on which part of the garage is being converted to a room. LPA spoke with Kim Fields, licensee, who stated that the room will not be use for other purpose other than a garage where she can use as storage. Licensee stated she went to the City and was informed that she can only use the unit as garage/storage.
2) The Accessory Dwelling Unit (ADU) which was started in April 2024 is completed and Daphna Garcia, administrator (ADM) and another staff has recently moved in to the ADU.

Licensee and/or administrator to submit the following by January 2, 2025:
-updated sketch showing the facility (front building), ADU and storage.
-sketch of the front building.

Exit interview conducted and copy of this report provided to the administrator.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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