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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601465
Report Date: 09/12/2024
Date Signed: 09/12/2024 09:36:41 AM


Document Has Been Signed on 09/12/2024 09:36 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:BORDEAUX SENIOR CARE, INC.FACILITY NUMBER:
015601465
ADMINISTRATOR:TAFT, JAMES R.FACILITY TYPE:
740
ADDRESS:1328 MONTROSE PLACETELEPHONE:
(925) 485-4573
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:6CENSUS: 0DATE:
09/12/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:James Taft, Administrator/LicenseeTIME COMPLETED:
09:50 AM
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On 9/12/2024 at 9:00AM, Licensing Program Analyst (LPA) G. Luk arrived to conduct a case management inspection regarding facility closure. LPA met with Administrator/Licensee, James Taft.

LPA toured facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor areas. LPA observed there were no residents present during inspection. Licensee has provided information regarding resident's relocation place. LPA was informed that the resident moved out in August of 2024. Licensee will try to find original license and send to LPA.

LPA will send forfeiture letter to licensee at a later time.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024
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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