198018831-8-13-2019-33-CC-CGRN-BEZVDQ-20190813162105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018831
Report Date: 08/13/2019
Date Signed: 08/13/2019 04:21:13 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 PRESCHOOL		FACILITY NUMBER:	198018831
ADMINISTRATOR:	MARLENE YBARRA		FACILITY TYPE:	850
ADDRESS:	311 S. NORMANDIE AVE.		TELEPHONE:	(213) 365-0909
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90020
CAPACITY:	63	CENSUS: 13	DATE:	08/13/2019
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	12:06 PM
MET WITH:	Marlene Ybarra		TIME COMPLETED:	04:30 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Crystal Green and Alicia Bailey conducted an unannounced Plan of Correction (POC) inspection to the above facility. Upon arrival, LPAs met with Marlene Ybarra, Director. The purpose of the POC inspection was to ensure the licensee is in compliance with the Title 22 regulations and corrections were made from the previous inspection conducted on 07/30/2019 that resulted in (1) Type A’s deficiency and (6) Type B’s deficiencies. The following deficiencies were cleared:

Buildings and Grounds: 101238(a), The facility front door was made inaccessible to unauthorized individuals. LPAs observed the facility to have installed a door keypad lock.

Fixtures, Furniture, Equipment and Supplies: 101239(b), LPAs observed all the window screens has been replaced.

Outdoor Activity Space: 101238.2(d)(2), LPAs observed the (3) small plants that was covered in thorns located in the children play yard had been removed.

Carbon Monoxide Detectors: 1596.954, LPAs observed the facility to have a carbon monoxide detector located in the Pre- K classroom.

Licensing staff reviewed the sign in sheets on todays visit, it was observed that only (9) children were signed in out of the (13) children that was present. At this time, LPA Green has not received the proof of correction for this deficiency. LPA advised the Director that failure to correct and/or provide proof of correction will result in the facility being issued a civil penalty. See 809D for citation.

*Report Continues Page 1 of 2*

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: PINE TREE PRESCHOOL	FACILITY NUMBER: 198018831
	VISIT DATE: 08/13/2019

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Facility has also been cited on 01/29/2019 for a broken toilet located next to the Pre-K classroom. During inspection conducted on 07/30/2019, licensing staff observed the same toilet to have a “out of order” sign displayed, facility was cited and given a POC date of 08/09/19. During this inspection, licensing staff observed the same toilet to have not been replaced and still had the "out of order" sign displayed on top of the toilet (pictures were obtained). LPA also observed there to be a water pressure issue with the remaining toilets located in the restroom area. This can potentially lead to the remaining toilets becoming overflowed and not operational for the children in care. Per Director, stated that she had someone look at the plumbing in the restroom but does not have any written proof from the repairman that this occurred. As a result, the facility is being issued a civil penalty for repeat violation.

Exit interview was conducted with Marlene Ybarra, Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. Notice of Site Visit provided and must be posted for 30 days. Failure to do so will result in a $100 civil penalty.

*Report Ends Page 2 of 2*

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: PINE TREE PRESCHOOL	FACILITY NUMBER: 198018831
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/16/2019 Section Cited CCR 101229.1(a)	1 2 3 4 5 6 7	The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.	1 2 3 4 5 6 7	Per Director, will create and implented a new sign in process to ensure that all parents or guradians are signing in and out their child. Director states she move the sign in book to each classroom to ensure that the parents are completing the sign in and sign out of the students. POC due to LPA by 08/16/2019.
	8 9 10 11 12 13 14	This requirement was not met as evidence by it was observed that only (9) children were signed in out of the (13) children that was present. This poses an potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
Type B 08/16/2019 Section Cited CCR 101239(e)(4)	1 2 3 4 5 6 7	All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition.	1 2 3 4 5 6 7	Per Director, will submit documentation showing that a certified plummer has inspected the broken toilet and addressed the water pressure issue with the remaining toilets in the restroom area. Proof of Correction will be submitted to the LPA by 08/16/2019.
	8 9 10 11 12 13 14	This requirement was not met as evidence by LPAs observed that the toilet located next to the Pre-K classroom has not been repired or replaced. This poses an potential risk to the health and safety of children in care.	8 9 10 11 12 13 14

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: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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