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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201125
Report Date: 12/01/2021
Date Signed: 12/01/2021 11:32:55 AM

Document Has Been Signed on 12/01/2021 11:32 AM - 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:GLEN EDENFACILITY NUMBER:
019201125
ADMINISTRATOR:RAMAS, ELINOREFACILITY TYPE:
735
ADDRESS:238 ESTHER COURTTELEPHONE:
(925) 239-5583
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 4CENSUS: 0DATE:
12/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Elinore Ramas - Administrator TIME COMPLETED:
11:35 AM
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On 12/01/2021 at 10:05 am Licensing Program Analysts (LPAs) L. Holmes and L. Hall conducted an announced pre-licensing inspection and met with Elinore Ramas - Administrator.

LPAs toured the clients bedrooms, bathrooms, common living areas, kitchen, garage and backyard. There are four (4) bedrooms, and three (3) bathrooms. There is sufficient lighting around the facility. Clients' rooms are equipped with the proper furniture, bedding and lighting. Hot water temperature is measured at 118.4 degrees Fahrenheit. LPAs observed locked cabinets that will store toxins and sharps and a locked mobile cart for medications. Required posters are posted on the wall. Thermometer in hallway showed temperature as 71 degrees F. Emergency disaster plan dated 07/30/2021. Fire extinguisher was last serviced on 07/22/2021. First Aid kit was complete. Carbon monoxide/smoke detectors were in working condition.

LPAs observed passageway to backyard obstructed by wooden planks, cardboard boxes, shovels, and a security door.

Issues were noted during inspection. LPAs 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 and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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