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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201271
Report Date: 02/25/2025
Date Signed: 02/25/2025 04:45:22 PM

Document Has Been Signed on 02/25/2025 04:45 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:MCLAUGHLIN MANORFACILITY NUMBER:
435201271
ADMINISTRATOR/
DIRECTOR:		JOYCELINE BUL-LALAYAOFACILITY TYPE:
735
ADDRESS:286 HERLONG AVENUETELEPHONE:
(408) 972-0562
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 5DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Joyceline Bul-lalayaoTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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 2/252025, Licensing Program Analyst (LPA) Maria (Mita) Partoza a conducted an unannounced required 1 year inspection visit and met with licensee/administrator (LIC/ADM) Joyceline Bul-lalayao and stated the purpose of the visit.

The facility is licensed to serve adults 18 to 59 6 may be non-ambulatory. LPA observed 4 out of 5 residents are present at the facility who are developmentally disabled. 2 out 6 staff were present. 1 out of 5 residents were out of the facility attending a day program.

At (time) LPA toured the facility inside and outside with ADM and Staff including but not limited to the kitchen, bathroom, dining room, living room, 3 out of 3 residents rooms, garage, backyard and exterior walkways. The temperature inside the home is 75 degrees Fahrenheit.

The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. Under the sink cabinet does not contain any chemicals. The kitchen and bathroom water temperature measured at 105 to 105.6 degrees Fahrenheit. 3 out of 3 resident's room have sufficient storage.

LPA observed that medications are kept locked and inaccessible to residents. The first aid kit is complete and is accessible to staff.

The backyard, walkways, ramps and patio are free from debris and obstruction. The facility screen windows were observed to be in good repair. The washer and dryer are in good working condition. Laundry soap and cleaning supplies are locked and not accessible to residents in care.

page 1 of 2 See LIC 809C
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 2
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: MCLAUGHLIN MANOR
FACILITY NUMBER: 435201271
VISIT DATE: 02/25/2025
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
26
27
28
29
30
31
32
The facility is equipped with a fire, smoke and carbon monoxide alert system that is in good working condition, night lights on the hallway are in good working condition. The hallway are free from obstruction.

LPA reviewed 3 out of 5 resident records such as but not limited to the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening and observed records to be complete and updated.

LPA reviewed 3 out of 6 staff records including but not limited to required training, first aid/CPR training, health screening and background clearance.

No deficiencies were cited during today's visit based on California Code of Regulation (CCR) Title 22.
An exit interview was conducted with administrator (ADM) Joyceline Bul-lalayao and copy of the report was provided.

Page 2 of 2
End of Report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2