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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201391
Report Date: 08/24/2021
Date Signed: 08/24/2021 11:57:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MANTE BOARD & CARE HOME IIFACILITY NUMBER:
275201391
ADMINISTRATOR:SAMSON MANTEFACILITY TYPE:
740
ADDRESS:1557 CUPERTINO WAYTELEPHONE:
(831) 442-3350
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:6CENSUS: 6DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Julia ManreTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Julia Mante, Adminsitrator/Licensee.

During visit, LPA Marrufo toured the facility. LPA toured the kitchen area, living room area, 3 out of 3 resident bedrooms, hallways, garage area, outdoor area, and hallway bathroom. LPA observed a visitor COVID-19 screening area at entrance. LPA observed COVID-19 related signs and posters throughout the facility. LPA observed the bathrooms had available soap and paper towels. LPA observed a 30-day PPE supply and a perishable food supply of at least two days and a non-perishable food supply of at least seven days.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Julie Mante and a copy of the report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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