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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020800
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:05:52 PM

Document Has Been Signed on 12/05/2024 03:05 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:
198020800
ADMINISTRATOR/
DIRECTOR:		KIMBERLY NGUYENFACILITY TYPE:
850
ADDRESS:802 VINELAND AVETELEPHONE:
(626) 277-9700
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 34DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Abagail MauleonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On December 5, 2024, at 2:30 pm Licensing Program Analysts (LPAs) Carolyn Tuba and Monica Ruiz conducted a case management inspection due to an incident that was self reported, and an Unusual Incident Report (UIR) was submitted by the facility. The incident occurred on 11/13/2024 where a parent had approached staff with a concern of their child. LPAs met with Assistant Director, Abagail Mauleon. LPAs observed and took a census of 34 children with 7 staff.

The incident was reported to the Department within the required 24 hours of occurrence.
During this investigation, LPAs conducted interview with Child #1 (C1).

No citations have been issued at this time.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Assistant Director, Abagail Mauleon.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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