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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708478
Report Date: 03/14/2025
Date Signed: 03/14/2025 03:37:40 PM

Document Has Been Signed on 03/14/2025 03:37 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:SANTO NINO RESIDENTIAL CARE HOME #1FACILITY NUMBER:
430708478
ADMINISTRATOR/
DIRECTOR:		DHORYDELL SISONFACILITY TYPE:
740
ADDRESS:105 CLAYTON AVENUETELEPHONE:
(408) 295-4112
CITY:SAN JOSESTATE: CAZIP CODE:
95110
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/14/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee Teodora SisonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst Marcella Tarin and Manuel Monter conducted an unannounced case management to issue a Civil Penalty that was inadvertently not issued on 3/13/2025. LPAs explained the purpose of the visit.

The Department is issuing an immediate civil penalty of $250 for a repeat violation for the following deficiencies:
On 12/26/2024 the facility was cited under code section 87303(a) Maintenance and Operation during an annual inspection.

On 3/13/2025 the facility was cited a repeat violation under code section 87303(a) Maintenance and Operation during a Case Management-Other.

This report was reviewed with Licensee Teodora Sison. An exit interview was conducted with Licensee Teodora Sison, and a copy of this report was provided.
Jin JackieTELEPHONE: (714) 319-3786
Marcella TarinTELEPHONE: (714) 328-5152
DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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