<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601181
Report Date: 10/22/2024
Date Signed: 10/22/2024 10:37:21 AM

Document Has Been Signed on 10/22/2024 10:37 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
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:
10/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Administrator, Jocelyn ManaloTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 22, 2024, Licensing Program Analyst (LPA) Murial Han conducted a follow-up Pre-Licensing inspection. LPA met with the administrator, Jocelyn Manalo and explained the purpose of today's visit,

During today's visit, LPA toured the facility with the administrator and observed the facility to be cleaned, tidy and comfortable. LPA observed medication, toxins and sharps are locked and inaccessible to residents in need. The indoor and outdoor passageways were free of obstruction.

During today's visit, there are 8 residents, 2 caregivers, and administrator.

Comp III orientation was given to the Administrator.

Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

Exit interview conducted with administrator.

A copy of the report is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1