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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020594
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:04:14 PM

Document Has Been Signed on 10/26/2023 01:04 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:
198020594
ADMINISTRATOR:KIMBERLY NGUYENFACILITY TYPE:
850
ADDRESS:14045 DILLERDALE STTELEPHONE:
(626) 338-3464
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 30DATE:
10/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kimberly NguyenTIME COMPLETED:
11:30 AM
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On October 26, 2023, Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management inspection due to an unusual incident report submitted by the facility on 9/20/2023. It came to the facility’s attention that Parent #1 (P1) alleged that an incident occurred at the facility in July 2023 with their Child #1 (C1). LPA met with Director, Kimberly Nguyen and Assistant Director, Abigail Mauleon. LPA was guided by Assistant Director on a tour to obtain the census of 30 children with 5 staff members who were fingerprint cleared. LPA conducted interviews. LPA obtained by the Director an internal incident report conducted by the facility.

The incident was reported to the Department within the required 24 hours of occurrence. The incident consisted with Parent alleging that their child’s personal rights were violated. LPA conducted interviews with the Director, Assistant Director and Staff #1 (S1) who was allegedly involved in the incident in July 2023. LPA attempted to contact P1 and left a voicemail. Child #1 (C1) was not present at the facility to interview.

Due to insufficient information at this time further investigation will need to be conducted.

No deficiencies were cited regarding today’s inspection.



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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