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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 11:40:35 AM
Document Has Been Signed on
12/01/2021 11:40 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 EDEN
FACILITY NUMBER:
019201125
ADMINISTRATOR:
RAMAS, ELINORE
FACILITY TYPE:
735
ADDRESS:
238 ESTHER COURT
TELEPHONE:
(925) 239-5583
CITY:
HAYWARD
STATE:
CA
ZIP CODE:
94544
CAPACITY:
4
CENSUS:
0
DATE:
12/01/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:35 AM
MET WITH:
Elinore Ramas, Administrator
TIME COMPLETED:
11:50 AM
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On 12/01/2021 at 11:35 am Licensing Program Analysts (LPAs) L. Holmes and L. Hall conducted an announced pre-licensing inspection with a Comp III and met with Elinore Ramas - Administrator.
Comp III was waived per Licensing Program Manager (LPM) H. Humpal.
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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