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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201390
Report Date: 11/07/2024
Date Signed: 11/07/2024 03:14:35 PM

Document Has Been Signed on 11/07/2024 03:14 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:BGC DAHILL RESIDENTIAL CAREFACILITY NUMBER:
019201390
ADMINISTRATOR/
DIRECTOR:		ANDALIS, MARIA VICTORIAFACILITY TYPE:
735
ADDRESS:1824 DAHILL LANETELEPHONE:
(510) 325-2414
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 0DATE:
11/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Eugene Elendu/Applicant, Maria Victoria 'Vickee' Andalis/Administrator and Maria Golitzen/ConsultantTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Eugene Elendu, applicant, Maria Victoria 'Vickee' Andalis, administrator, and Maria Golitzen, consultant.

LPA presented the training via Power Point presentation and had a discussion with the applicant, administrator and consultant..

Exit interview conducted and copy of this report provided at the conclusion of the training.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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