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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202205
Report Date: 09/01/2021
Date Signed: 09/01/2021 03:36:29 PM

Document Has Been Signed on 09/01/2021 03:36 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:SANTOS CARE HOMEFACILITY NUMBER:
435202205
ADMINISTRATOR:MICHELLE S. SANTOSFACILITY TYPE:
735
ADDRESS:1706 MT. RANIER AVE.TELEPHONE:
(408) 469-7154
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 6DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Michelle SantosTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Joanne Roadilla conducted an unannounced Infection Control site visit today. LPA met with Administrator (ADM) Michelle Santos to discuss the purpose of the visit.

LPA toured the facility inside and out with ADM. Facility was observed to have a designated entry point for universal symptom screening. Hand sanitizers were available and all staff present were observed wearing masks.

At around 2:00pm, kitchen and all bathrooms were inspected and observed supplied with hygiene products and with hand washing signs posted. Bedrooms, dining room, living room, and the outside grounds were inspected. All fire exit routes were clear of obstruction. Medications, toxins, cleaning supplies, knives and sharp objects were secured. Facility was also observed to have adequate supply of Personal Protective Equipment (PPEs).

LPA reviewed the facility COVID-19 related infection control policies and procedures with ADM including screening, surveillance testing, disinfecting, staffing, training, isolation, PPE use and inventory. Per ADM, all staff and residents are 100% vaccinated.

No deficiencies issued per Title 22 of the California Code of Regulations. LPA reviewed report with, and a copy provided to Michelle Santos.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Joanne Roadilla
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2021
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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