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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200238
Report Date: 02/18/2026
Date Signed: 02/20/2026 08:48:59 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/20/2026 08:48 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SNOW WHITE CARE HOMEFACILITY NUMBER:
435200238
ADMINISTRATOR/
DIRECTOR:		WANG, JAMESFACILITY TYPE:
740
ADDRESS:431 MUNDELL WAYTELEPHONE:
(650) 814-4400
CITY:LOS ALTOSSTATE: CAZIP CODE:
94022
CAPACITY: 6CENSUS: 5DATE:
02/18/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Administrator/Licensee - James WangTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 02/18/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced Required 1-Year Annual inspection. LPA met with the caregiver Merlita initially, then the licensee, James Wang. LPA explained the purpose of today's visit. There are 3 staff persons present, including the licensee/administrator and 3 residents.

This facility is licensed for ages 60 and over. One bedridden resident is allowed in room 4 and 5 non-ambulatory. Hospice waiver for 4 residents. No residents on hospice as of today's inspection. There are 6 bedrooms and 4 bathrooms designated for residents' use. All resident rooms are single occupancy. LPA inspected all 6 resident rooms and found them clean, appropriate lighting, and equipped with the required furniture as outlined in Titel 22. LPA inspected 2 full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can with lid, and non-skid mats. The hot water temperature is measured at 116F. LPA inspected the kitchen and found it clean and fully operational appliances. LPA observed a locked cabinet containing knives and sharp objects, and a locked cabinet under the sink with detergents and cleaning supplies. Medication closet is located near the kitchen as well and is observed to be locked and in order. The refrigerator and pantry cabinets are inspected. Sufficient supplies of fresh perishable food for 2 days and nonperishable supplies for 7 days are observed. Fire extinguisher is observed in the kitchen adjacent to the kitchen sink. Inspection tag is observed as inspected on 09/29/2025. Combination carbon monoxide and smoke detectors are observed in place and tested as functional.

Continued on following page.

NAME OF LICENSING PROGRAM MANAGER: Cara Smith
NAME OF LICENSING PROGRAM ANALYST: Jaime Vado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 435200238
VISIT DATE: 02/18/2026
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LPA inspected the garage and found it clean and organized. Facility washer and dryer is in place and both are functional. Incontinence supplies are stored in the garage as well as a staff refrigerator. The emergency exit routes are observed as free and clear of any obstructions on both sides of the facility. The backyard area patio, ramps, and walkways are observed as clear and in good repair. Shed is observed as being used for storage reasons only. First aid kit is present and equipped with the required items. Last disaster drill, which is a fire drill, was conducted on 01/05/2026.

LPA reviewed 3 staff files and 5 resident file during today's visit. Based on file review, all files are observed to be current for both residents and staff. Medications are observed to logged and current per observations made. No updated documents requested as per the licensee there has been no changes to staff. All administrator certificates are still current and were provided to previous LPA. And designated responsible staff is the same as last year.

No deficiencies were cited during today's visit.

Report is reviewed with the licensee and a copy is provided on this day.

NAME OF LICENSING PROGRAM MANAGER: Cara Smith
NAME OF LICENSING PROGRAM ANALYST: Jaime Vado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC809 (FAS) - (06/04)
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