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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004738
Report Date: 12/09/2024
Date Signed: 12/09/2024 03:31:43 PM

Document Has Been Signed on 12/09/2024 03:31 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 CENTERFACILITY NUMBER:
198004738
ADMINISTRATOR/
DIRECTOR:		KYM ALLENFACILITY TYPE:
850
ADDRESS:1444 E. HOLT AVE., ROOM 3TELEPHONE:
(909) 994-3796
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 0DATE:
12/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Facilities planner Kym AllenTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On 12/9/24 at 2:40pm, Licensing Program Analysts (LPA)'s Stephanie Li and Kamile Martin conducted a case management follow up visit at the Pomona Unified District Child Development Center for the purpose of following up and obtaining Child 1, (IFSP) Individual family service plan records for a UIR reported to the department regarding physical personal rights on 11/25/24 that had occurred on 11/22/24. LPA's met with Kym Allen who provided the child's file for review.

A UIR case management follow up visit was conducted on 12/03/24 to the Pueblo preschool program. UIR was submitted under the wrong facility number. Incident occurred in the preschool room. Child has disability diagnosis from the regional center, (IPP) Individual Program Plan) document equivalent to IEP between regional center and parent. According to Child development supervisor, parent does not agree with the IPP from Regional Center and requested district to conduct their own assessment.

IFSP and IEP is not available for review as services have not been planned yet. Assessment plan for child is scheduled with PUSD and EDSS (Early developmental search and serve) department. EDSS postponed original assessment date from 10/17/24 to 12/17/24. LPA's obtained notes from Disability Coordinator, Leslie Lopez regarding referrals and assessments. Child's file was also reviewed and photos were captured during this visit. Head Start and Early Learning Division Health history form was obtained documenting child's health history of speech therapy, aggression, and witness to domestic violence.

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 Facilities Planner Kym Allen.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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