Snow White Care Home

On 02/18/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced Required 1-Year Annual inspection. LPA met with the caregiver Merlita initially, then the licensee, James Wang. LPA explained the purpose of today's visit. There are 3 staff persons present, including the licensee/administrator and 3 residents. This facility is licensed for ages 60 and over. One bedridden resident is allowed in room 4 and 5 non-ambulatory. Hospice waiver for 4 residents. No residents on hospice as of today's inspection. There are 6 bedrooms and 4 bathrooms designated for residents' use. All resident rooms are single occupancy. LPA inspected all 6 resident rooms and found them clean, appropriate lighting, and equipped with the required furniture as outlined in Titel 22. LPA inspected 2 full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can with lid, and non-skid mats. The hot water temperature is measured at 116F. LPA inspected the kitchen and found it clean and fully operational appliances. LPA observed a locked cabinet containing knives and sharp objects, and a locked cabinet under the sink with detergents and cleaning supplies. Medication closet is located near the kitchen as well and is observed to be locked and in order. The refrigerator and pantry cabinets are inspected. Sufficient supplies of fresh perishable food for 2 days and nonperishable supplies for 7 days are observed. Fire extinguisher is observed in the kitchen adjacent to the kitchen sink. Inspection tag is observed as inspected on 09/29/2025. Combination carbon monoxide and smoke detectors are observed in place and tested as functional. Continued on following page. 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 Page 2 LPA inspected the garage and found it clean and organized. Facility washer and dryer is in place and both are functional. Incontinence supplies are stored in the garage as well as a staff refrigerator. The emergency exit routes are observed as free and clear of any obstructions on both sides of the facility. The backyard area patio, ramps, and walkways are observed as clear and in good repair. Shed is observed as being used for storage reasons only. First aid kit is present and equipped with the required items. Last disaster drill, which is a fire drill, was conducted on 01/05/2026. LPA reviewed 3 staff files and 5 resident file during today's visit. Based on file review, all files are observed to be current for both residents and staff. Medications are observed to logged and current per observations made. No updated documents requested as per the licensee there has been no changes to staff. All administrator certificates are still current and were provided to previous LPA. And designated responsible staff is the same as last year. No deficiencies were cited during today's visit. Report is reviewed with the licensee and a copy is provided on this day.

On May 15, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management visit for a welfare check on four (R1-R4) residents, who were relocated from another facility. Upon arrival, the LPA was greeted by the Licensee, James Wang. The LPA disclosed the purpose of the visit. LPA toured the facility and observed all four (4) residents who moved/relocated from the facility located at 3835 Mumford Place, Palo Alto, CA 94306. Two (2) residents were watching TV in the living room, one (1) resident was watching TV in their room, and one (1) resident was sitting on a table in the kitchen. LPA reviewed the resident records for all four residents and were observed to be complete. LPA observed two (2) caregivers present at the facility. The licensee stated that they have updated all the records for the residents after they moved/relocated. No deficiencies were cited during today's visit. An exit interview was conducted with the Licensee. A copy of this report was provided to the Licensee, James Wang, whose signature on this form confirms receipt of the report.

On February 12, 2025, at 08:50 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the caregiver, Merlita Bathan, and disclosed the purpose of the inspection. The caregiver informed the LPA that the facility had (1) resident in care and (1) staff member present at the time. The Licensee, James Wang, joined shortly after. At 9:28 AM, the LPA initiated a walk-through of the facility, accompanied by the licensee. LPA inspected the lobby room and observed it clean, with all furniture in good repair. LPA inspected the living room. There was a television, fireplace with a mesh screen, dining table, and dining chairs to accommodate the residents. There were (6) bedrooms and (4) bathrooms designated for residents' use. All resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. LPA inspected (2) full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip mats. The hot water temperature at the sink faucet measured 118.6°F in bathroom #1 and 119.8°F in bathroom #2. LPA inspected the kitchen and found it clean, with no cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects, and a locked cabinet under the sink with detergents and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the fire extinguisher mounted on the wall in the kitchen and found it fully charged, with the last service tag dated 09/26/2024. The licensee tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Continued on LIC809-C 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 LPA inspected the garage and found it clean. A washer, a dryer, and cabinets with incontinence supplies were observed. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. No bodies of water were noted. The LPA inspected (1) storage shed and observed wheelchairs, furniture items, bedframes, and mattresses, stored in the shed. LPA reviewed (2) staff personnel records and (1) resident records. The LPA observed that 1 of 1 resident had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 2 of 2 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 2 of 2 staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet inside the kitchen. Medications were organized in separate bin for the resident. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 11/24/2024. The following updated forms are requested to be submitted to CCLD by 02/19/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Current Control of Property (Lease or Deed) Document Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Licensee. A copy of this report was left with the Licensee, James Wang, whose signature on this form confirms receipt of the report.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Merlita Bathan. During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the facility kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. A first aid kit was observed and found to be complete. LPA Marrufo toured 3 out of 3 resident bathrooms. The bathroom water temperatures ranged from 114 F to 119 F. Each bathroom had functioning lights and available soap and paper towels. LPA Marrufo toured 6 out of 6 bedrooms. Each bedroom had available bedding and clothing storage areas as well as working lights. The smoke detectors and carbon monoxide detectors were tested and found to function properly when tested. The outdoor area was toured and the exits were clear of obstructions. LPA Marrufo reviewed resident and staff records and found them to be complete. The last recorded Emergency Disaster Drill was conducted on 11/24/2023. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Merlita Bathan and a copy of this report was provided.

Licensing Program Analysts (LPA) David Marrufo and Manuel Monter conducted an unannounced Required 1 Year visit and met with Administrator James Wang. During visit, LPAs observed a visitor screening area at the entrance. LPAs observed 2 out of 2 hallway bathrooms and observed available soap, paper towels, and hand washing signs. LPAs observed a 30-day supply of PPEs. There was a perishable food supply of 2 days and a non-perishable food supply of at least 7 days in the facility food storage areas. LPA Marrufo observed stored cleaning supplies. The outside area was toured and the exits were observed to be clear of obstructions. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator James Wang and a copy of the report was provided.