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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020799
Report Date: 10/07/2021
Date Signed: 10/07/2021 04:39:58 PM

Document Has Been Signed on 10/07/2021 04:39 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 INFANT CARE CENTERFACILITY NUMBER:
198020799
ADMINISTRATOR:KIMBERLY NGUYENFACILITY TYPE:
830
ADDRESS:802 VINELANE AVETELEPHONE:
(626) 277-9700
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/07/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Kimberly Nguyen TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Cynthia Reyes, conducted an announced pre-licensing site Inspection to inspect and measure the requested Infant component for capacity determination. LPA met with Kimberly Nguyen, applicant. Due to COVID- 19 precautionary measures were taken during the entire inspection and all individuals present during this inspection wore appropriate personal protective equipment. The applicant is requesting a total capacity of 14 Infants. Days & hours of the Infant license will be Monday-Friday 6AM-6 PM

At 12 noon, LPA began the tour of the facility with Kimberly, beginning at the office. Kimberly states infant parents will enter and exit the gate off Vineland Street. During Covid parents will sign the child in/out (Clean pins will be available and a container for used pins), outside of the front door of infant room #7 (Where small infant yard is located). Temperatures and health checks will be conducted. Use of hand sanitizer will also be available. Parents will not enter the class rooms at this time unless they request to enter, which at that time all precautionary measures will be taken for that individual entering. Facility staff will walk the child inside the class room and bring the child out at pick up time. LPA observed a parent board placed outside by the sign in/out area during Covid with all licensing forms and Covid-19 posters. LPA observed inside the class room the parent board visible for all to see with all licensing documents and Covid-19 posting as well. Facility was observed to be adhering to local public health guidelines. (According to CDC guidelines, children under the age of (2) are not required to wear masks.)

The ill/isolation area is located in the main office and is close to the staff rest room for an ill child to use. The ill/isolation area has a cot for a child to rest if needed. A staff lounge/lunch area is located in the kitchen area that is used just for snack/meal prep and no cooking.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
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 INFANT CARE CENTER
FACILITY NUMBER: 198020799
VISIT DATE: 10/07/2021
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12:30 PM, The tour continued as the LPA was guided to the Infant outdoor play area. The Infants have their own Big and small outdoor play yard (Grass, padding & cement), and is self contained by a gate around it for separation from the preschool yard to prevent children from commingling. Water jugs with disposable cups or labeled bottles will be used for children while outdoors. LPA observed age appropriate outdoor toys and play equipment to be clean safe and in good repair, as well as adequate shade is available. All areas around play equipment and slides are cushioned with material to absorb a fall. Measurements were taken of the outdoor play yards (Big & Small) and the total outside capacity allows for 19 Infants (Big yard 11 Capacity/Small yard 8 capacity). LPA advised the owner Kimberly that the Infant children need to be within the direct care and supervision, including visual observation and supervision of the teacher(s) at all times.

12: 45 PM Licensing staff was then guided through the new proposed Infant class rooms (#7 & #6). Toys were observed to be age appropriate clean and safe. Furniture and equipment was inspected for age appropriateness and good repair. Napping equipment (Cribs & Cots) were also inspected and observed to be in good condition. Appropriate storage and cleanliness was observed. The Infants will bring their own labeled water bottle. Lunch and AM/PM snack will be provided by the facility and infants will bring their own formula and water if needed and labeled. Menus were observed. Containers used to discard food have tight fitting lids. Cleaning compounds are inaccessible to the children. There is a fully equipped first aid kit available on site. Individual storage space was observed to be available for each child. Parents will bring each child's linen for the week and take home at the end of the week. Facility has extra linen and food available if needed. Measurements for Room #6/Capacity is 7 infants and Room #6/Capacity is 7)

Infant bathroom was observed to be in good repair, water temperature, paper towels, toilet paper, all area inspected for safety and sanitation. One toilet (15 infants) and one sink (15 infants) with a changing table in arms reach was observed and inspected.

1PM There is a smoke detectors, a carbon monoxide detector and a fire extinguisher (Service date 05/19/2021) that meets statutory requirements. Heating, lighting and ventilation were evaluated. Building/Rooms are centrally heated and air conditioned. Overhead lights as well as natural light is used.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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 INFANT CARE CENTER
FACILITY NUMBER: 198020799
VISIT DATE: 10/07/2021
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Food preparation areas were toured for safety and cleanliness. Carbon monoxide detectors and smoke detectors are present and are in operable condition in the facility. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Hazardous items including poisonous cleaning compounds were observed to be stored inaccessible to children.

1:35 PM Items discussed during this Inspection:

Licensing does not tolerate the following: Refused Entry to a Facility or Any Part of a Facility is a
violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both.
Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.
Current Children’s Roster LIC 9040: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This children roster must be updated and available to the licensing agency upon request.
Pediatric First Aid and CPR: At least one person in the facility, along with the Director/Administrator must be trained in Pediatric First Aid and CPR and present in the facility.
Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.
Qualifications and staff files: Educational background, training, and/or experience and all required documents by the department for each staff present must be available for review.
Children’s Records: All required licensing documents must be available for review; 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. Director advised to visit www.shotsforschool.org for immunization information.
Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or
volunteer at a day care center if he or she has not been immunized against influenza, pertussis, & measles.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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 INFANT CARE CENTER
FACILITY NUMBER: 198020799
VISIT DATE: 10/07/2021
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Continued: Items discussed during this Inspection:

Criminal background clearance: LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.
Reporting Requirements Section 101212: Changes at the facility must be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.

2:15PM Facility has no transportation policy. Applicant states that any lifesaving medication will be stored in a locked area inaccessible to children in care in the kitchen.

Incidental Medical Services (IMS): This facility does not plan at this time to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.



2:30PM LPA consulted with applicant regarding COVID-19 health and safety guidelines on this date. Applicant was provided forms to post via email. Licensing staff observed COVID- 19 postings posted in different areas of the day care for parents, as well as for children at eye level in their class rooms and in the bathrooms on this date. During this inspection LPA also discussed PIN 20-06 CCP, Social and Physical Distancing Guidance and Healthy Practices for Child Care Facilities in Response to The Global Corona virus (COVID-19) Pandemic Written in Collaboration with The California Department of Education. LPA handed the applicant the Child Care Covid-19 Self-Assessment guide during this inspection on this date. The applicant filled out and handed the department a copy on 10/07/2021. LPA discuss the Self-Assessment guide with applicant Kimberly. .
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PUENTE AVE PRESCHOOL INFANT CARE CENTER
FACILITY NUMBER: 198020799
VISIT DATE: 10/07/2021
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LPA advised the applicant how to access forms, regulations providers information notices (PINs), regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

INFANT CARE: LPA advised director, Cribs or play yard shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA advised no infants to be swaddled while in care. LPA advised the applicant that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.



SAFE SLEEP: LPA discussed the safe sleep regulations with applicant Kimberly and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Based on LPA measurements taken on this date and observations of the facility, No corrections are needed and the facility will be approved for 14 Infants indoors and outdoors. The application will be submitted to be licensed after completion of final file review. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A fire clearance was approved on 10/04/2021 and on file for a capacity of 14.

3 PM, Exit interview was conducted in person with Kimberly Nguyen. A copy of this report and Appeal Rights were discussed, signed, given and printed on this date. Consultation regarding the licensing state laws and regulations, were conducted through out this inspection.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
LIC809 (FAS) - (06/04)
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