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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 419210112
Report Date: 04/09/2024
Date Signed: 04/09/2024 06:03:16 PM

Document Has Been Signed on 04/09/2024 06:03 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ELENA'S HOMEFACILITY NUMBER:
419210112
ADMINISTRATOR/
DIRECTOR:		LYNDON M GANIRFACILITY TYPE:
735
ADDRESS:1075 17TH AVENUETELEPHONE:
(650) 454-9905
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 4CENSUS: 4DATE:
04/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Reycel Martin, House Manager and Lyndon Ganir, AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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On April 9, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 4:00 PM, to conduct the Annual 1-year required visit. LPA Calandra was greeted by Reycel Martin, House Manager and explained the purpose of his visit. Lyndon Ganir, Administrator arrived later during the visit.

LPA Calandra toured the physical plant. This is a 1 story building with 4 bedrooms, 2 bathrooms, a den, living room, front and backyards and a garage. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of waters or hazards were observed. Fire alarms and Carbon Monoxide detectors were observed to be in working condition. The facility fire extinguisher was observed to be fully charged and last checked on July 19, 2023. Hot water temperature was measured at 106.7 degrees Fahrenheit well within the required range of 105-120. The facility had the required 7 days of non-perishables and 2 days of perishable foods on site. No food was expired.

All knives, sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care.

LPA Calandra interviewed 3 staff and 2 clients.

LPA Calandra requested a copy of the Administrator's current Administrator's certificate and received it at the facility.

No deficiencies were cited during today's visit.

The Annual inspection will be completed at a later date.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ELENA'S HOME
FACILITY NUMBER: 419210112
VISIT DATE: 04/09/2024
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This report was reviewed with Administrator, Lyndon Ganir and Reycel Martin, House Manager and a copy of the report left at the facility.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
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