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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198020800
Report Date: 06/26/2024
Date Signed: 06/26/2024 01:56:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2024 and conducted by Evaluator Carolyn Tuba
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20240501081342

FACILITY NAME:PUENTE AVE PRESCHOOLFACILITY NUMBER:
198020800
ADMINISTRATOR:KIMBERLY NGUYENFACILITY TYPE:
850
ADDRESS:802 VINELAND AVETELEPHONE:
(626) 277-9700
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY:56CENSUS: 30DATE:
06/26/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Abigail MauleonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not report incident to appropriate parties
INVESTIGATION FINDINGS:
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On 6/26/2024 at 9:20 am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced complaint inspection to conduct further interviews and deliver findings of the above allegation. A Covid risk assessment was conducted. LPA met with Assistant Director, Abigail Mauleon. LPA observed a census of 30 children with 9 staff.

LPA was unable to interview Reporting Party. LPA conducted interviews on 5/8/2024, 5/31/2024 and 6/26/2024 with Director, Assistant Director, Staff #1 (S1), #2 (S2), #3 (S3), #4 (S4), Child #1 (C1), #2 (C2) #3 (C3) and Parent #1 (P1). LPA attempted to interview Parent #2 (P2), #3 (P3), #4 (P4) and #5 (P5) but was unable to make contact.

Reporting Party alleges that Staff did not report incident to appropriate parties.
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 33-CC-20240501081342
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 198020800
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
101212(d)
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d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours........
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LPA consulted with the Director and Assistant Director of reporting requirements. LPA has asked Assistant Director to watch the video Reporting Requirements on the CCLD's website: https://ccld.childcarevideos.org/child-care-center-operators/ and agrees to write up what she learned and submit to the LPA.
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This requirement is not met as evidenced by: due to interviews conducted with Assistant Director and Director that the Department was not notified of a reportable incident. This poses/posed a potential Health and Safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 33-CC-20240501081342
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 198020800
VISIT DATE: 06/26/2024
NARRATIVE
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When LPA arrived during the initial visit of 5/8/2024, Assistant Director stated that while they had done an internal investigation, she was not aware that it needed to be reported. Director was under the same impression. LPA stated that anytime there is anything unusual or if a parent brings up a concern pertaining to their child being hurt by someone at the school either staff, children, other parents, or volunteers, the Facility may conduct their own internal investigation, but the facility is also requires to report it to the Department via telephone the first 24 hours and submit an Unusual Incident Report (UIR) within 7 days by mail, email or fax.

Based on interviews, which were conducted the preponderance of the evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, 101227(1) the deficiency is being cited on the attached LIC 9099D.

Notice of site visit was given and must remain posted for 30 days, exit interview conducted and report was reviewed with the Assistant Director, Abigail Mauleon.
Page 2 of 2
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5