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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708479
Report Date: 12/20/2021
Date Signed: 12/20/2021 10:00:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SANTO NINO RESIDENTIAL CARE HOME #2FACILITY NUMBER:
430708479
ADMINISTRATOR:DHORYDELL SISONFACILITY TYPE:
740
ADDRESS:91-93 CLAYTON AVENUETELEPHONE:
(408) 295-4112
CITY:SAN JOSESTATE: CAZIP CODE:
95110
CAPACITY:4CENSUS: 0DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Dhorydell SisonTIME COMPLETED:
10:02 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Dhorydell Sison.

During visit, Administrator Sison stated that the facility is no longer operating as a licensed care facility and does not currently have any residents. She stated the last two residents left the facility in June 2021. LPA Marrufo advised Administrator Sison that the facility license still needs to be surrendered before the facility can be formally closed with CCL.

LPA Marrufo toured the facility and observed two out of two resident bedrooms, hallways, kitchen, bathroom, and living area and did not observe any residents.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Administrator Dhorydell Sison and a copy of the report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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