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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201125
Report Date: 11/23/2021
Date Signed: 11/23/2021 02:31:11 PM

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:GLEN EDENFACILITY NUMBER:
019201125
ADMINISTRATOR:RAMAS, ELINOREFACILITY TYPE:
735
ADDRESS:238 ESTHER COURTTELEPHONE:
(925) 239-5583
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:4CENSUS: 0DATE:
11/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Elinore RamasTIME COMPLETED:
12:45 PM
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On 11/23/2021 at 12:00 PM, Licensing Program Analyst (LPAs) L Holmes and L Hall arrived announced to conduct Pre-Licensing required inspection. LPA met with Administrator Elinore Ramos and explained the purpose of the visit. The facility currently has no clients.

Upon entry to the facility LPAs observed flooring not complete and a handyman completing repairs within the facility. LPA's advised Administrator that we would have to return to complete the licensing inspection once all work has been completed.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrators and a copy of this report will be emailed.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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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