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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202651
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:18:19 PM

Document Has Been Signed on 03/11/2025 04:18 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:
03/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:21 PM
MET WITH:Emmanuel FernandoTIME VISIT/
INSPECTION COMPLETED:
03:22 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Emmanuel Fernando.

LPA toured the facility inside and out with HM. 3 staff and 3 residents were observed in the facility.

LPA reviewed 2 resident files and 2 staff files.

Licensee, and personal right posters were observed in the facility. ADM showed the documents that he/she renewed the Administrator Certificate. Living room, office, kitchen, dinning room, and two restrooms were inspected. Three single resident bedrooms, garage, and laundry room were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 71 degree F, and hot water temperature was at 105 degree F in facility. The temperature of the refrigerator was at 40 degree F, and the temperature of the freezer was at 0 degree F. Flash lights, night lights, and first aid box were observed in the facility.

Fire extinguisher was serviced on 06/28/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. carbon monoxide detectors were tested by staff. The smoke detectors were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

The last time the facility conducted the emergency and fire drill is 3/3/2025.

No citation noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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