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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202052
Report Date: 01/16/2025
Date Signed: 01/16/2025 12:53:20 PM

Document Has Been Signed on 01/16/2025 12:53 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:MARILAG'S CARE HOMEFACILITY NUMBER:
435202052
ADMINISTRATOR/
DIRECTOR:		WENNIE R. CONCEPCIONFACILITY TYPE:
740
ADDRESS:2293 LANAI AVE.TELEPHONE:
(408) 272-3155
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
01/16/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator Wennie ConcepcionTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On January 16, 2025, LPA Monter conducted a case management POC visit. LPAs met with Administrator, Wennie Concepcion

On January 9, 2025, the facility was issued the following citations with a POC due date of January 10, 2025. On January 10, 2025, the licensee requested POC extension from 01/10/2025 to 1/17/2025.

The following deficiencies were cited during an annual inspection January 9, 2025 are as follows:
  • 87307(d)(6), Personal Accommodations and Services (Type A). Cleared on 1/16/2025, during visit.
  • 87309 Storage Space and Access (a). Cleared on 1/16/2025, during visit.
  • 87468.1 Personal Rights of Residents in All Facilities (a)(2). Still pending. ADM stated she will send LPA this pending POC by end of day.
  • 87507 Admission Agreements (d). ADM stated she has filled out the form and will send to LPA by end of day.


No deficiencies cited during todays visit. A copy of the report was provided.
Romeo ManzanoTELEPHONE: (408) 388-2297
Manuel MonterTELEPHONE: (408) 324-2112
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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