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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603499
Report Date: 09/15/2021
Date Signed: 09/15/2021 04:09:03 PM

Document Has Been Signed on 09/15/2021 04:09 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:SPOELSTRA LLC DBA VOICE LA PUENTEFACILITY NUMBER:
198603499
ADMINISTRATOR:STOCK, PATRICIAFACILITY TYPE:
775
ADDRESS:13907 "D" E AMAR ROADTELEPHONE:
(909) 792-2428
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 100CENSUS: DATE:
09/15/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
02:34 PM
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COMP II by CAB successfully completed

Facility Type: Adult Day Care
Application Type: CHOW
Capacity: 100
Census (if any clients in care): N/A
Method: Telephone call with CAB
COMP II Participants: Lester Spoelstra, Owner; Shannon Betker, analyst.

Applicant participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant was verified by confirming driver’s license number. During COMP II, applicant confirmed the understanding of Title 22. Component II was successfully completed.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type
2. Staff qualifications and responsibilities
3. Staff training
SUPERVISORS NAME: Jude De La Concepcion
LICENSING EVALUATOR NAME: Shannon Betker
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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