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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200238
Report Date: 02/22/2024
Date Signed: 02/22/2024 12:50:41 PM


Document Has Been Signed on 02/22/2024 12:50 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: 5DATE:
02/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Merlita BathanTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Merlita Bathan.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the facility kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. A first aid kit was observed and found to be complete.

LPA Marrufo toured 3 out of 3 resident bathrooms. The bathroom water temperatures ranged from 114 F to 119 F. Each bathroom had functioning lights and available soap and paper towels. LPA Marrufo toured 6 out of 6 bedrooms. Each bedroom had available bedding and clothing storage areas as well as working lights. The smoke detectors and carbon monoxide detectors were tested and found to function properly when tested.

The outdoor area was toured and the exits were clear of obstructions.

LPA Marrufo reviewed resident and staff records and found them to be complete. The last recorded Emergency Disaster Drill was conducted on 11/24/2023.

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

This report was reviewed with Merlita Bathan and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
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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