198019478-12-17-2019-33-CC-CGUA-BL9R8V-20200128114834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019478
Report Date: 12/17/2019
Date Signed: 12/17/2019 01:17:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2019 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20191113162400

FACILITY NAME:	PUENTE AVE PRESCHOOL INFANT CARE CENTER		FACILITY NUMBER:	198019478
ADMINISTRATOR:	KIMBERLY NGUYEN		FACILITY TYPE:	830
ADDRESS:	14032 DILLERDALE AVE		TELEPHONE:	(626) 338-3464
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91746
CAPACITY:	30	CENSUS: 14	DATE:	12/17/2019
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kimberly Nguyen		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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9

Infant sustained injury while in care.
Infant left in soiled diaper for an extended period.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Judy Mora conducted a subsequent complaint inspection to conclude the investigation in regards to the above complaint allegations. LPA met with Director, Kimberly Nguyen, who guided LPA on a tour of the facility.

During the course of the investigation LPA conducted interviews with staff and other potential witnesses. LPA also reviewed and obtained records. There were no disclosures made. Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview conducted with Kimberly Nguyen. Appeal Rights explained and provided to the director during this visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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