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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202238
Report Date: 12/16/2024
Date Signed: 12/16/2024 08:57:56 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/16/2024 08:57 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:FANTASIA CARE HOMEFACILITY NUMBER:
435202238
ADMINISTRATOR/
DIRECTOR:		FERDINAND/MERLITA PATIOFACILITY TYPE:
735
ADDRESS:98 CHERRY BLOSSOM DR.TELEPHONE:
(408) 281-1992
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Merlita Patio, LicenseeTIME VISIT/
INSPECTION COMPLETED:
09:05 AM
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On December 16, 2024, at 8:35 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA rang the doorbell and knocked at the front door, but no one answered the door. LPA called the phone number on file and talked to Licensee, Ferdinand Patio. Soon after Licensee, Merlita Patio, opened the door and let the LPA inside.

Licensee stated that the house is in middle of construction and don’t have any clients yet. They stated that they are not operating since they applied for licensing and are just not ready. They don’t have any idea when they will be operating and are going back and forth with San Andreas Regional Center (SARC).

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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