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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202651
Report Date: 02/19/2025
Date Signed: 03/02/2025 09:18:04 PM

Document Has Been Signed on 03/02/2025 09:18 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:MERIDIAN MANOR IVFACILITY NUMBER:
435202651
ADMINISTRATOR/
DIRECTOR:		EMMANUEL G FERNANDOFACILITY TYPE:
735
ADDRESS:1502 CONSTANSO WAYTELEPHONE:
(408) 882-3908
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 3CENSUS: 3DATE:
02/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Emmanuel FernandoTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst Steve Chang conducted an unannounced case management visit and met with Administrator (ADM) Emmanuel Fernando.

The purpose of today's visit is to deliver an amended investigation report issued to ADM on 12/06/2024. .

On 12/06/2024, an investigation report was issued to ADM for complaint number 26-AS-20241028165255. The Department amended the investigation report due to new evidence was obtained.

No deficiencies were cited during todays visit.

Exit interview was conducted with ADM. This report were provided to ADM for signature. A copy of this report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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