198019699-10-23-2023-33-CC-CTUA-CWW23X-20231023170304

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019699
Report Date: 10/23/2023
Date Signed: 10/23/2023 05:03:22 PM

Document Has Been Signed on 10/23/2023 05:03 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		FACILITY NUMBER:	198019699
ADMINISTRATOR:	KIMBERLY NGUYEN		FACILITY TYPE:	840
ADDRESS:	14032 DILLERDALE ST		TELEPHONE:	(626) 338-3464
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91746
CAPACITY: 5	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Kimberly Nguyen		TIME COMPLETED:	05:00 PM

NARRATIVE

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On 10/23/2023, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced required Annual inspection. A Covid risk assessment was conducted. LPA met with Director, Kimberly Nguyen. LPA was guided on a tour of the facility indoors and outdoors. LPA observed that there was a census of 0 children. This is a school-age program licensed for 5 children, which operates Monday through Friday from 6:00 AM to 6:00 PM. Per the Director, there are no children currently enrolled. School-age is only available for holiday, summer, and school breaks.

The following classrooms was inspected: School age classroom located upstairs from preschool program which serves 7 to 14 years old. This is part of a preschool and infant licensed child care center. Child's restroom is available as well as staff.

The classroom furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Indoor classroom was inspected to ensure that the floors have a surface that is safe and clean. Telephone service, heating, lighting, and ventilation were evaluated. Storage for infants’ belongings was inspected and meet all regulatory requirements. Availability of drinking water was reviewed and per Director the classroom provides water for the children by either using filtered water from the kitchen or using bottled water and placed in a pitcher with disposable cups. Toys observed to be clean.

Carbon monoxide detectors and smoke detectors are present in the facility. Fire extinguishers are serviced annually and was last serviced 6/8/2022. Per the Director, she will be taking Fire extinguishers to be serviced on 10/24/2023 and she will be taking a photo of the new service tag and will text to LPA proof of service. Storage cabinet in classrooms was locked and hazardous items including poisonous cleaning compounds were found accessible to children under bathroom sink with no child-proof lock. Emergency disaster drill was last conducted on 10/2023. There is a First Aid kit available inside the classroom; the supplies were inventoried and found to be in good condition.

Food preparation areas were toured for safety, cleanliness, and proper equipment. The facility serves and is part of a food program. Menu is posted in the classroom, on the parent app and the playground.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PUENTE AVE PRESCHOOL	FACILITY NUMBER: 198019699
	VISIT DATE: 10/23/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Outdoor playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There are tables and

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PUENTE AVE PRESCHOOL	FACILITY NUMBER: 198019699
	VISIT DATE: 10/23/2023

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basketball court. There is adequate shade in the play yard. There is enough equipment for the children to use in the play yard. Area is gated with iron gates at least 6 feet tall and staff check the area for any harmful objects prior to children playing in the play area.

Sign in and out sheets are kept in the classroom for easy access for parents. LPA reminded Director that parents should be using full signature when sign in or out their child.

Children files were reviewed and complete. Staff files were reviewed and complete. Clearance for adults and verification of CPR/First Aid, current mandated reporting certificates, educational requirements and health preventative practices documentation was reviewed. Children’s records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. The Director and staff currently have immunization documentation.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The following deficiencies on the attached LIC 809 deficiencies page is being cited in accordance with CA code of Regulations Title 22. 101212(d)(1) Reporting Requirements.

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: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/23/2023 05:03 PM - It Cannot Be Edited

Created By: Carolyn Tuba On 10/23/2023 at 04:44 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: PUENTE AVE PRESCHOOL	FACILITY NUMBER: 198019699
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in cleaning products were under the bathroom sink and does not have a childproof lock which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/30/2023
	Plan of Correction
1 2 3 4	Per Director will install child-proof lock and take a picture and submit to LPA. LPA observed that there are no children in care at this time.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ana Chico

LICENSING EVALUATOR NAME:

Carolyn Tuba

LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC809 (FAS) - (06/04)

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