198020594-8-5-2025-33-CC-MRUZ-DK9UES-20250805153138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020594
Report Date: 08/05/2025
Date Signed: 08/05/2025 03:31:54 PM

Document Has Been Signed on 08/05/2025 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:	PUENTE AVE PRESCHOOL ICC LLC		FACILITY NUMBER:	198020594
ADMINISTRATOR/ DIRECTOR:	KIMBERLY NGUYEN		FACILITY TYPE:	850
ADDRESS:	14045 DILLERDALE ST		TELEPHONE:	(626) 338-3464
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91746
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 42	CENSUS: 36	DATE:	08/05/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Director, Kimberly Nguyen		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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On 8/5/2025 Licensing Program Analysts (LPAs) Monica Ruiz and Mary Silva arrived at the facility noted above to conduct an unannounced annual inspection. A risk assessment was conducted. LPA presented identification, explained reason for the visit, and provided the Entrance Checklist - Child Care Centers form (LIC 125). Facility Representative (FR) Kimberly Nguyen guided LPAs on a tour of the facility. This is a preschool program which is currently licensed for a capacity of 42 children and operates Monday – Friday from 6:00 AM – 6:00 PM. Per Lead Teacher there are 40 children enrolled.

Census was taken upon arrival, and the following staff and children were observed by LPAs to be present: Preschool Room#1 had 1 Staff with 10 children, Preschool Room 2-3 had 2 Staff and 20 children, and Toddler Room 4 had 1 Staff with 6 children. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded.

At 2:15PM, all children were observed by LPAs to be under supervision, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license. All areas identified on the Facility Sketch were inspected and the following was observed: All indoor classrooms were inspected to ensure that furniture and equipment are age-appropriate and in good repair, and the floors have a surface that is safe and clean.

Napping equipment, cots, including mats and bedding were inspected for good condition and appropriate storage. LPAs observed children’s bedding to be stored so that napping equipment and bedding are touching other children’s bedding. LPAs advised Lead Teacher to store children’s bedding so that bedding for one child does not come into contact with another child’s bedding, and according to regulations. Per Lead Teacher, children’s bedding is washed weekly by the facility. Each staff member is assigned a laundry day. Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PUENTE AVE PRESCHOOL ICC LLC	FACILITY NUMBER: 198020594
	VISIT DATE: 08/05/2025

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Storage for children's belongings was inspected and LPAs observed children to have their own labeled cubbies to store their belongings in all classrooms. Children bring water bottles from home and are allowed to drink freely at any time. Water bottles are refilled on demand from a water pitcher located in the classroom. Water pitchers are refilled in the kitchen from a water filtration system.

LPAs observed toys and materials for children in the classrooms such as books, art supplies, blocks, sensory toys.

Age-appropriate sinks and toilets were inspected for availability and good repair in restrooms used by children. All materials and surfaces accessible to children appear to be toxic free.

Per Director, the children the couch area as an isolation area. Per Preschool Teacher, staff provide 100% supervision when ill child is using the isolation room and/or restroom, and parents are contacted immediately when children are determined to be ill, and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Food menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Menus for the past 30 days are available upon request. The facility provides breakfast, lunch, and one snack. All kitchen, food preparation, and food storage areas are clean and free of litter, rubbish, and rodents, and other vermin. All food is protected from contamination, and LPAs inspected that any contaminated food is discarded immediately. LPAs inspected food to be of good quality and quantity.

Director states that there are no poisons or firearms on the premises.

First aid kits were located in each classroom. Telephone service, heating, lighting and ventilation were evaluated. LPAs observed the facility to have operable carbon monoxide and smoke detectors located.

The facility has two outdoor play areas that are fully fenced. LPA observed there to be tricycles, a bike path, play houses, a play structure for climbing and a slide. There is adequate shade in the play yards. There are safe toys, play equipment and materials observed for children outside on playground. LPAs advised FR to maintain cushioning under outdoor equipment and to maintain a fall space around climbing equipment.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: PUENTE AVE PRESCHOOL ICC LLC	FACILITY NUMBER: 198020594
	VISIT DATE: 08/05/2025

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LPAs reviewed facility roster and Disaster Drill log. Last drill was conducted on 7/2/25. LPAs observed all required posted forms to be posted in the office and on the wall outside of the Preschool entrance.

At 2:30 PM Staff Records and Children’s Records were reviewed. LPAs observed children’s files reviewed to be complete. Inspection of required forms were made. Children’s files reviewed contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

LPA observed at least one person present during the inspection to be trained in Pediatric First Aid and CPR. LPA reviewed staff files, including Health Screenings. Staff immunization records (Influenza, Measles, and Pertussis) were reviewed, and observed to be complete.

LPAs advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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.

Facility representative 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.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: PUENTE AVE PRESCHOOL ICC LLC	FACILITY NUMBER: 198020594
	VISIT DATE: 08/05/2025

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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 child care 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 with 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/. PIN 22-05-CCP

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

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Kimberly Nguyen.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

LIC809 (FAS) - (06/04)

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