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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197406974
Report Date: 02/02/2023
Date Signed: 02/02/2023 04:35:42 PM


Document Has Been Signed on 02/02/2023 04:35 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:GIVING TREE ACADEMY: SCHOOL-AGE PROGRAMFACILITY NUMBER:
197406974
ADMINISTRATOR:YUN JEONG YIFACILITY TYPE:
840
ADDRESS:1111 CRENSHAW BOULEVARDTELEPHONE:
(323) 935-7971
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:59CENSUS: 25DATE:
02/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Yun Jeong Yi, Director TIME COMPLETED:
04:40 PM
NARRATIVE
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On 02/02/2023, Licensing Program Analyst (LPA) Denise Miranda, conducted a Case Management- Deficiencies visit for the purpose of citing for the deficiencies that were observed during the visit on 02/02/2023.

LPA met with Yun Jeong Yi, Director. There were 25 children in care being supervised by 2 Staff and Director.

Director was unable to produce copy of LIC9040 – Child Care Facility Roster, and do not retain for 3 years.



Per Director, facility was unable to provide proof of current CPR/first aid.
LPA reviewed the mandated report certificate for all staff and observed that certification were expired on 01/16/2020. Director was unable to provide proof of current mandate report certificate for all staff.

Per Director, facility pick up children from school and facility was unable to provide copy of written permission from the children's parents, due the transportation.

Base on observation interviews, and supportive documents, records reviewed, it has been determined that the facility has violated Child Care Licensing Regulation Title 22. (See pages LIC809-D).


LPA will send an email to Director along with LIC311A form.
An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit was provided and reviewed with Yun Jeong Yi, Director.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 02/02/2023 04:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: GIVING TREE ACADEMY: SCHOOL-AGE PROGRAM
FACILITY NUMBER: 197406974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2023
Section Cited

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§1596.841 Current roster of children provided care in facility required. 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 roster shall be available to the licensing agency upon request.
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Per Director, she will submit to LPA the Children Roster no later than 2/13/2022 from 01/2021 to current 2023.
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This not met the evidence: by on 02/02/23, Director was unable to produce copy of the children's roster.Per Director she does not retain per 3 years. This is poses potential risk for the children in care.
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Type B
02/10/2023
Section Cited

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101216 (f) f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
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Director will provide provide proof of pediatric/ first aid for at least one staff. Director will submit proof via email to LPA Miranda no later than 2/10/23.
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This requirement is not met as evidenced by:on 02/02/2023, Director was unable to provide proof of current of Pediatric First/Aid.
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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.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2