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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200238
Report Date: 02/02/2023
Date Signed: 02/02/2023 02:28:15 PM

Document Has Been Signed on 02/02/2023 02:28 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SNOW WHITE CARE HOMEFACILITY NUMBER:
435200238
ADMINISTRATOR:WANG, JAMESFACILITY TYPE:
740
ADDRESS:431 MUNDELL WAYTELEPHONE:
(650) 814-4400
CITY:LOS ALTOSSTATE: CAZIP CODE:
94022
CAPACITY: 6CENSUS: 4DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:James WangTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPA) David Marrufo and Manuel Monter conducted an unannounced Required 1 Year visit and met with Administrator James Wang.

During visit, LPAs observed a visitor screening area at the entrance. LPAs observed 2 out of 2 hallway bathrooms and observed available soap, paper towels, and hand washing signs. LPAs observed a 30-day supply of PPEs. There was a perishable food supply of 2 days and a non-perishable food supply of at least 7 days in the facility food storage areas. LPA Marrufo observed stored cleaning supplies. The outside area was toured and the exits were observed to be clear of obstructions.

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

This report was reviewed with Administrator James Wang and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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