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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707358
Report Date: 12/23/2024
Date Signed: 12/24/2024 08:01:51 AM

Document Has Been Signed on 12/24/2024 08:01 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/
DIRECTOR:
MATTHEW MIAOFACILITY TYPE:
772
ADDRESS:17415 & 17425 DEPOT STREETTELEPHONE:
(408) 778-0555
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 12CENSUS: 11DATE:
12/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:27 AM
MET WITH:Vickie Romero & Maria Cortes, Delia RamosTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 12/23/24, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Peer Partners Vickie Romero, Program Specialists Delia Ramos & Maria Cortes. LPA explained the purpose of the visit.

LPA toured the facility inside and outside and no obstructions were observed. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be organized and fully furnished with adequate lighting. Bathrooms are equipped with toilet, showers, paper products, hygiene supplies, and hand washing signs. Smoke detector observed in the hallway of each sleeping area in the facility. Facility temperature was at 70 deg F. Fire extinguishers last serviced on 05/29/2024. Carbon monoxide detectors present in the hallway of each sleeping area. Sharps and toxic materials were observed to be locked. Food supply was observed with an adequate two day perishable and seven day non-perishable.

LPA reviewed 6 resident files to contain an admission agreement, medical assessment, TB result, appraisal/needs and services plan, emergency forms, safeguard of personal property and valuables, and personal rights.

Medication review was done, and centrally stored medication is updated, medication is locked in a cabinet and inaccessible to residents.

Annual inspection will be continued on a later date.

No deficiencies are cited at this time.

Report is reviewed and a copy is provided
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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