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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707358
Report Date: 12/30/2024
Date Signed: 12/30/2024 10:40:20 AM

Document Has Been Signed on 12/30/2024 10:40 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: 10DATE:
12/30/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Matthew MiaoTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 12/30/24, LPA Grace Donato made an unannounced continuation of the annual visit to the facility. LPA met with Program Director Matthew Miao. LPA explained the purpose of the visit.

LPA reviewed five staff files. Staff have current First Aid/CPR certifications on file. Emergency drills are done every month.

LPA received the following documents: LIC500 and facility sketch.

No deficiencies cited today. Report is reviewed and copy is provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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