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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708479
Report Date: 06/17/2022
Date Signed: 06/17/2022 03:22:08 PM


Document Has Been Signed on 06/17/2022 03:22 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, 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:
06/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Dhorydell SisonTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced final walk through visit for the facility closure, and met with administrator (ADM) Dhorydell Sison.

LPA toured the facility inside out with ADM. The facility house is a duplex including #91 and #93 houses. #91 has 1 bedroom, 1 bathroom, 1 living room, 1 dinning room and 1 kitchen. #93 house has 2 bedrooms, 1 bathroom, 1 living room and 1 kitchen. Front yard and back yard were observed and inspected.

No residents or staff were observed in facility. The facility was observed as at non-operational status.

ADM stated all the residents were relocated to other facilities.

Exit interview was conducted with ADM. This report was provided to ADM for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
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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