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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200841
Report Date: 04/05/2024
Date Signed: 04/05/2024 05:06:37 PM

Document Has Been Signed on 04/05/2024 05:06 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:ELENA'S CARE HOME LLCFACILITY NUMBER:
019200841
ADMINISTRATOR/
DIRECTOR:		TABING, BONNIE JEANFACILITY TYPE:
735
ADDRESS:22349 WESTERN BLVDTELEPHONE:
(510) 690-1710
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 5DATE:
04/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:15 PM
MET WITH:Bonnie Jean Tabing/Administrator TIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On April 21, 2023 during last year's annual inspection, Bonnie Jean Tabing, administrator, informed Licensing Program Analyst (LPA) Delmundo of the plan to have an Accessory Dwelling Unit (ADU) erected behind the facility. LPA discussed the following: obtaining permit prior to construction; ensuring the health and safety of residents; fire safety inspection to be requested by LPA once construction is completed. LPA told the the administrator to inform LPA when final decision in made to have ADU added.

On March 20, 2024, the administrator informed LPA that the City of Hayward has allowed the addition of ADU.

On this day, April 5, 2024, LPA observed the construction of ADU has started. LPA obtained copy of building permit. LPA informed and requested the administrator to submit the following once construction is completed:
1. Facility sketch
2. ADU sketch
3. LIC9054 Local Fire Inspection Authority Information

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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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