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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601181
Report Date: 10/10/2024
Date Signed: 10/10/2024 01:31:13 PM

Document Has Been Signed on 10/10/2024 01:31 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:J AND J MANALO'S BOARD AND CAREFACILITY NUMBER:
415601181
ADMINISTRATOR/
DIRECTOR:		MANALO, JOCELYNFACILITY TYPE:
740
ADDRESS:2595 OAKMONT AVENUETELEPHONE:
(650) 273-9103
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 8CENSUS: 8DATE:
10/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Licensee, Jocelyn ManaloTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On October 10, 2024 Licensing Program Analyst (LPA), Murial Han met with the administrator at Manalo's Board and Care IV Josefina Manalo to conduct a pre-licensing inspection as the administrator/licensee was not available. LPA explained the purpose of today's visit.

This is a single level facility that consists of 9 rooms. All the rooms are private, and 5 rooms have exit doors to outside. There is a staff room and 3 full bathrooms. Washer and dryer are located in 2-car garage. There are 8 residents during the time of inspection. The indoor and outdoor passageways were free of obstruction. The facility observed to clean, and tidy. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable.

LPA observed postings including CCL complaint poster, resident's rights, facility sketch, LTC Ombudsman poster, etc.

The water temperature in the bathroom and the kitchen were measured at 105- 108 degrees F.

LPA observed laundry supplies and equipment to be adequate.

Pre-Licensing is incomplete during this inspection as LPA observed medication cabinets, disinfectants and chemicals were unlocked and accessible to residents in care. Deficiency is cited under Manalo's Board & Care IV.

LPA will proceed with a follow-up pre-licensing inspection.

This report is reviewed and discussed with the administrator of Manalo's Board & Care IV.

A copy of this report is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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