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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019478
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:51:19 PM

Document Has Been Signed on 09/09/2024 12:51 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. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PUENTE AVE PRESCHOOL INFANT CARE CENTERFACILITY NUMBER:
198019478
ADMINISTRATOR/
DIRECTOR:		KIMBERLY NGUYENFACILITY TYPE:
830
ADDRESS:14032 DILLERDALE AVETELEPHONE:
(626) 338-3464
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: DATE:
09/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kimberly NguyenTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On September 9, 2024, at 9:00 am Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management inspection due to an incident that occurred at the facility on 9/3/2024. LPA met with Assistant Director, Abigail Mauleon and Director, Kimberly Nguyen. A Covid Risk Assessment was conducted. LPA took a census of 27 children with 10 staff.

LPA conducted interviews with Director, Assistant Director and Staff #1 (S1). During this visit LPA obtained the Childcare Facility Roster, written parent statement and staff information. On 9/3/2024 Parent #1 (P1) informed Director of an alleged incident with S1 pertaining to the personal rights of a child that had occurred on 8/29/2024 and on 8/30/2024. LPA reviewed video footage dated 8/29/2024 and 8/30/2024 and Assistant Director forwarded to LPA via email. LPA offered consultation regarding the incident and Emergency Procedures.

The incident was reported to the Department within the required 24 hours of occurrence.



At this time, the facility is in compliance with California Code of Regulations Title 22, therefore no deficiencies were cited during today’s visit inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Kimberly Nguyen.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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