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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707358
Report Date: 08/08/2022
Date Signed: 08/08/2022 11:23:21 AM

Document Has Been Signed on 08/08/2022 11:23 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:LA CASA DEL PUENTEFACILITY NUMBER:
430707358
ADMINISTRATOR:VICKI PACHECOFACILITY TYPE:
772
ADDRESS:17415 & 17425 DEPOT STREETTELEPHONE:
(408) 778-0555
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 12CENSUS: 8DATE:
08/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Vicki PachecoTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management visit and met with Administrator, Vicki Pacheco and Case Manager, Isabel Garza. LPA explained the purpose of the visit was to look into a concern regarding the designated smoking area.

During visit, LPA observed the facility's exterior to include the backyard and front area. The facility originally had five scheduled time slots for smoking. The original dedicated smoking area was located in the facility's backyard.

On 08/03/2022, the Administrator received an email and call from the City of Morgan Hill regarding a concern on second hand smoke traveling into the neighbor's property. On the same day, the Administrator removed the ash trays located in the backyard and designated a new smoking area located on the drive way at the front of the facility, facing Depot Street. The facility has reduced the scheduled time slots for smoking to three times a day. The clients were informed of the new schedule and the new smoking location. LPA observed the smoking schedule posted throughout the facility. Administrator stated to have received good feedback of the new smoking area from the neighbor.

LPA obtained the facility's LIC500, resident roster, and new smoking schedule.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Vicki Pacheco, Peer Partner, Vickie Romero, and Case Manager Isabel Garza and copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2022
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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