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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019699
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:07:11 PM

Document Has Been Signed on 10/26/2023 01:07 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 PRESCHOOLFACILITY NUMBER:
198019699
ADMINISTRATOR:KIMBERLY NGUYENFACILITY TYPE:
840
ADDRESS:14032 DILLERDALE STTELEPHONE:
(626) 338-3464
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kimberly NguyenTIME COMPLETED:
12:15 PM
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On 10/26/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced POC (plan of correction) inspection to ensure the deficiency cited on 10/23/2023 for the annual visit has been corrected. A COVID risk assessment was conducted. LPA met with Director, Kimberly Nguyen and Assistant Director. LPA observed 0 children in care and no staff present at the facility during this inspection due to school-age is only conducted during holiday and school breaks.

Correction of Citation: LPA observed that the cabinet under the sink in the children’s restroom was made inaccessible by installing a child safe lock as cleaning products are kept in that cabinet.

During the visit of 10/23/2023 LPA noted that fire extinguishers were found to have last been serviced June of 2022. LPA observed and Director sent LPA photos of the tag showing that it had been serviced on October 24, 2023.

LPA cleared the deficiency on this date and provided a copy of the POC clearance letter during the visit.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

Notice of site visit was given to the Director and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.



Exit interview conducted and report was reviewed with the Director, Kimberly Nguyen.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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