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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600488
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:54:52 PM

Document Has Been Signed on 11/16/2023 03:54 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PUNZALAN HOME VFACILITY NUMBER:
198600488
ADMINISTRATOR:PUNZALAN, ED & ERLINDAFACILITY TYPE:
735
ADDRESS:13314 ASHWORTH PL.TELEPHONE:
(562) 404-2899
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 4CENSUS: 3DATE:
11/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Administrator Erlinda PunzalanTIME COMPLETED:
02:30 PM
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On 11/16/2023 at 12:32 pm, Licensing Programming Analyst (LPA) Jewel Baptiste conducted a case management visit to review the Restricted health plan the facility submitted on 10/18/2023. LPA was greeted by Staff#1 who contacted the Administrator. At 1:00 pm, The Administrator Erlinda Punzalan arrived, and LPA explained the reason for the visit.

During todays visit LPA conducted a tour of the facility and received an update regarding the client who needed a restricted health care exemption. According to the Administrator the facility is withdrawing their request for a restricted health condition exemption. The facility stated the client no longer has the condition and will be starting the day program on Monday.

LPA obtained a copy of the physician’s approval for the client to return to the day program and the Administrator will email LPA with the physician’s discontinue order.

Exit interview conducted and a copy of the report provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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