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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018831
Report Date: 07/30/2019
Date Signed: 07/30/2019 04:19:38 PM

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:PINE TREE PRESCHOOLFACILITY NUMBER:
198018831
ADMINISTRATOR:ANGIE GOMEZFACILITY TYPE:
850
ADDRESS:311 S. NORMANDIE AVE.TELEPHONE:
(213) 365-0909
CITY:LOS ANGELESSTATE: CAZIP CODE:
90020
CAPACITY:63CENSUS: 20DATE:
07/30/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Marlene YbarraTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Crystal Green and Alicia Bailey conducted an unannounced complaint inspection to investigate the allegation above. LPAs met with, Marlene Ybarra, Director, who guided analyst on a tour of the facility both inside and outside. Census was taken.

The purpose of this visit was to ensure that the licensee is in compliance with Title 22 regulations. Upon arrival, LPAs reviewed the sign in and out sheets and observed that only 10 children were signed in, however after census was taken it was determined that 20 children were present at the time of inspection. During LPAs inspection of the facility building and grounds, LPAs observed several broken screen windows located in the hallway leading to the Little Bears classroom the largest measured more than 9 inches. LPAs observed several broken screen windows that measures more than 2 feet wide located in the Bunnies classroom. LPAs observed a child in the Bunnies classroom were able to put their hand through the broken screen from inside the classroom and was able to touch the window panel located outside. According to Title 22 California Code of Regulation, all window screens shall be in good repair and free of insects, dirt and debris.

During LPAs inspection of the indoor space, the carbon monoxide detector was tested in the Bunnies classroom and the Little Bears classroom. It was determined that both carbon monoxide detectors are non-operational. During LPAs inspection of the outdoor space, the facility was observed to have (3) small plants located in the children play yard that contains sticky thorns similar to a cactus plant. LPA also observed the cushioning surface of the play area to contain gaps between the black squares which poses a tripping hazard to the children in care.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Director. Appeal rights and procedures were explained and provided.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
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 3
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: PINE TREE PRESCHOOL
FACILITY NUMBER: 198018831
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2019
Section Cited
CCR
101239(b)
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All window screens shall be in good repair and free of insects, dirt and debris.


This requirement was not met as evidence by LPAs observed several broken screen windows located in the hallway leading to the Little Bears
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Per Director, will need to contact licensee to develop a plan, and replace the screen. Will submit proof correction to LPA by 08/09/19.
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classroom the largest measured more than 9 inches. LPAs observed several broken screen windows that measures more than 2 feet wide located in the Bunnies classroom. This poses an potential risk to the health and safety of the children in care.
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Type B
08/09/2019
Section Cited
CCR
101238.2(d)(2)
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The surface of the outdoor activity space shall be maintained: Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirements was not met as evidence by
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Per Director, will have the (3) plants removed and will repair or replace the black cushioning squares. Will submit prood of correction to LPA by 08/09/2019.
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the facility was observed to have (3) small plants located in the children play yard that contains sticky thorns similar to a cactus plant. LPA also observed the cushioning surface of the play area to contain gaps between the black squares which poses as a tripping hazard to the 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.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: PINE TREE PRESCHOOL
FACILITY NUMBER: 198018831
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2019
Section Cited
CCR
101229.1(a)(1)
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The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
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Per Director, will implented a new sign in process and will submit proof of the new procedure to LPA by 08/09/2019.
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This requirement was not met as evidence by LPAs reviewed the sign in and out sheets and observed that only 10 children were signed in, however after census was taken it was determined that 20 children were present at the time of inspection. This poses an potential risk to the health and safety of the children in care.
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Type B
08/09/2019
Section Cited
HSC
1596.954
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Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.
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Per Director, will obtain new carbon monoxide detectors and will submit proof to LPA by 08/09/2019.
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This requirement was not met as evidence by the carbon monoxide detector was tested in the Bunnies classroom and the Little Bears classroom. It was determined that both carbon monoxide detectors are non-operational.
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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: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3