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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017611
Report Date: 12/03/2024
Date Signed: 12/03/2024 02:10:44 PM

Document Has Been Signed on 12/03/2024 02:10 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PUEBLO CHILD DEVELOPMENT, HSFACILITY NUMBER:
198017611
ADMINISTRATOR/
DIRECTOR:		KYM ALLENFACILITY TYPE:
830
ADDRESS:1460 E. HOLT AVE., HS1 & HS2TELEPHONE:
(909) 994-3796
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
12/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH: Lead Teacher Janie LealTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA)s Kamile Martin and Stephanie Li conducted an unannounced Case Management inspection due to an incident that occurred on 11/22/24 and was reported to the Department on 11/25/24. A COVID risk assessment was conducted. LPA’s met with Lead Teacher to whom the reason for the visit was explained. Lead Teacher guided LPA’s on a tour of the facility. There were 13 children present and 3 teaching staff. The facility was observed to be operating within the license capacity limitations. Hours of operation are from 7:30am – 2:00pm.

On 11/22/24, an unusual incident report was made to the Department regarding an incident that occurred. The parent sent a text message to the PUSD family service advocate (FSA). In the message the child is saying that a teacher pulled his ear and it hurt. PUSD also reported the incident to CPS. LPA’S discovered UIR is attached to the wrong facility number. This incident occurred in the preschool classroom Pueblo HS3 198004738.



During today’s visit, LPA K Martin interviewed Lead Teacher privately. During the interview, lead teacher disclosed that she has no information about the incident that occurred before the thanksgiving holiday. Lead teacher was notified by parent on Monday 12/2/24 that the parent called PUSD FSA and notified her that the incident occurred before Thanksgiving break.
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Christina GabelmanTELEPHONE: (323) 981-3380
Kamile MartinTELEPHONE: 323-981-3350
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PUEBLO CHILD DEVELOPMENT, HS
FACILITY NUMBER: 198017611
VISIT DATE: 12/03/2024
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Lead Teacher informed LPA that the child has behavior problems and has been diagnosed with Mild Intellectual Disability from the Regional Center since October 11,2024. The child began the program on August 14, 2024. Lead teacher described child as needing additional behavior support. The district was going to provide special ed evaluation for services. Per parent Special Education evaluation was rescheduled from October to December. Child attends additional childcare services after school at a family childcare home. FCC picks the child up daily from school; mom drops child off daily.

Lead teacher disclosed that campus supervisor is not supposed to take children to the restroom at all per Lead Teacher has not observed her doing so. Her role is to support with meals and supervision, not discipline. Per teacher, discipline policy is to redirect children and support with problem solving with open ended questions. Ouch/incident reports are written if children are casually hurt during the day and the child has no other incidents reported in school. Lead teacher did express child arrived to school with a bruise on his face 12/2/24 and mom said she fell into him causing a bruise on his left temple.


Based on information obtained during this investigation, additional follow up is necessary regarding the incident reported. No deficiencies are being cited at this time.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Lead Teacher Janie Leal.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Kamile MartinTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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