<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408195
Report Date: 10/25/2023
Date Signed: 10/26/2023 09:47:36 AM

Document Has Been Signed on 10/26/2023 09:47 AM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FORTES, ELOISA & SANTINOFACILITY NUMBER:
434408195
ADMINISTRATOR:FORTES, ELOISA & SANTINOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 934-9209
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Licensees Eloisa and Santino FortesTIME COMPLETED:
11:00 AM
NARRATIVE
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
On Wednesday, October 25, 2023, at 10 am, Licensing Program Analysts (LPA) Manel Estoesta conducted a Required One (1) Year Visit. LPA met with Licensee Eloisa and Santino Fortes and explained the purpose of the visit. Present on this visit was the Licensee's adult son and no children in care during the visit.

The licensees have current CPR and First Aid ID cards. The licensee completed the Mandated Reporter Child Care Providers training online at https://mandatedreporterca.com/

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Notice of site visit was given and must remain posted for 30 days.

Failure to comply with postal requirements shall result in an immediate civil penalty of $100.

The exit interview conducted, and report was reviewed with the Licensees Eloisa and Santino Fortes.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1