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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201271
Report Date: 02/14/2023
Date Signed: 02/14/2023 02:01:00 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/14/2023 02:01 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MCLAUGHLIN MANORFACILITY NUMBER:
435201271
ADMINISTRATOR:JOYCELINE BUL-LALAYAOFACILITY TYPE:
735
ADDRESS:286 HERLONG AVENUETELEPHONE:
(408) 972-0562
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 5DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:JOYCELINE BUL-LALAYAOTIME COMPLETED:
09:59 AM
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Licensing Program Analyst (LPA) Steve Chang conducted an annual inspection visit, and met with Administrator (ADM) JOYCELINE BUL-LALAYAO. Upon arrival, ADM took LPA body temperature and checked LPA into the guest book. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance.

LPA toured the facility inside and out with ADM. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet and cleaning product closet were observed locked. There are 3 bedrooms for residents, and three staff live-in room in facility. 2 bathrooms are in facility. Paper towels were observed with holders, Trash cans were observed with covers. Posters of washing hands for 20 seconds were not observed in kitchen and restroom. ADM stated the facility will put the posters of washing hands for 20 seconds by the sinks in the kitchen and restrooms within 5 days. Cloth towels were observed in kitchen. Room temperature was observed at 70 degree F, and hot water temperature was observed at 115 degree F. 2 days perishable food supplies and 7 days non perishable food supplies were observed sufficient.

The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. ADM tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 05/27/2022. LPA inspected the backyard, there was no obstruction to block the walkway. ADM stated all staff and residents are fully vaccinated and done with booster.

No citation noted during inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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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