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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004138
Report Date: 11/22/2022
Date Signed: 11/22/2022 04:42:27 PM

Document Has Been Signed on 11/22/2022 04:42 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SANTOS HOMEFACILITY NUMBER:
306004138
ADMINISTRATOR:CRISTINA SANTOSFACILITY TYPE:
735
ADDRESS:11731 DEBBIE LANETELEPHONE:
(714) 621-0355
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 5DATE:
11/22/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
04:24 PM
MET WITH:Macorazon Demaclid, caregiverTIME COMPLETED:
05:00 PM
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On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Alvaro Ramirez Jr. conducted an unannounced case management visit to the facility for the purpose of issuing a Technical Advisory to the licensee.

During the visit, LPAs spoke with multiple members of staff including staff member S1. A Guardian query showed that staff member S1 does have a current background clearance but does not appear to be associated to the facility.

A Technical Advisory was issued in regards to the licensee's responsibility to maintain accurate and current staff associations for all staff members.

An exit interview was conducted and a copy of this report along with the technical advisory were provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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