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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018831
Report Date: 07/30/2019
Date Signed: 07/30/2019 04:15:44 PM



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
07/22/2019 and conducted by Evaluator Crystal Green
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20190722104912

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
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Marlene YbarraTIME COMPLETED:
02:07 PM
ALLEGATION(S):
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Facility in disrepair.
Facility has vermin.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Crystal Green and Alicia Bailey conducted an unannounced complaint inspection to investigate the allegations above. LPAs met with, Marlene Ybarra, Director, who guided analyst on a tour of the facility. Census was taken.

Allegation states facility is in disrepair. Reporting Party (RP) alleges that the front door to the facility is broken and often doesn’t lock. RP also alleges that there are several toilets in the facility that are broken. Upon arrival to the facility LPAs observed the front door to have a keypad that had a piece of paper covering it, which indicted that it is not in service. LPAs was able to gain access to the facility through the unlocked front door. This facility is located next to a high traffic street with a homeless population wandered nearby. This poses an immediate risk to the health and safety of the children in care. Upon entry to the facility LPAs observed that no one was present or aware the LPAs had entered the facility. LPAs also observed that the Dragonfly classroom door was open and accessible next to the front entrance door. LPAs obtained pictures.
*Report continues on the next page*
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 33-CC-20190722104912
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: 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(e)(4)
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All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.
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Per Director, will have the toilet replaced. proof of corrections will be submitted to LPA by 08/09/2019
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This requirement was not met as evidence by LPAs observed a toilet located in the girl’s restroom that was taped off with a sign that says, “out of order”. This poses an potential risk to the health and safety of children in care.
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Type B
08/09/2019
Section Cited
CCR
101238(a)(1)
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The licensee shall take measures to keep the center free of flies, other insects, and rodents.
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Per Director, will have pest control come out to the facility, proof of corrections will be submitted by LPA by 08/09/2019.
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This requirement was not met as evidence by During LPAs tour of the Dragonfly classroom, LPAs and Director observed a large cockroach that appeared to be deceased. LPAs also observed another deceased cockroach in the empty classroom next to the Bunnies room. This poses an potential risk to the health and saftey of 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
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 33-CC-20190722104912
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: PINE TREE PRESCHOOL
FACILITY NUMBER: 198018831
VISIT DATE: 07/30/2019
NARRATIVE
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LPAs observed a toilet located in the girl’s restroom that was taped off with a sign that says, “out of order”. After conducting a facility file review, this facility has been cited during an inspection conducted on 01/29/2019 by licensing staff for a toilet that needed repair and was also observed again during an inspection conducted on 03/01/2019 to still need repair, per licensing records this facility has not submitted proof of corrections regarding the broken toilet. This poses a potential risk to the health and safety of the children in care.

Allegation states that facility has vermin. RP alleges that they observed large cockroaches and rats at the facility. During LPAs tour of the Dragonfly classroom, LPAs and Director observed a large cockroach that appeared to be deceased, however once Director attempted to remove the cockroach it was not deceased. There were 3 children present in the classroom that were playing on the floor next to that area. LPAs also observed another deceased cockroach in the empty classroom next to the Bunnies room. During LPAs inspection of the girl’s restroom located next to the Little Bears room, LPAs observed rat feces located under the sink. LPAs obtained pictures.

Based on LPAs observation, the preponderance of evidence standard has been met, therefore the above allegations is found to be substantiated. California Code of Regulations, (Title 22, Division & Chapter) relating to this allegation have been cited on LIC 9099-D.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the director will also provide copies to the parents of the children in care for up to one year. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was explained and provided to the Director.

Exit interview was conducted with the Director. The Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.
*Report Ends*
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
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 33-CC-20190722104912
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: 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 A
07/31/2019
Section Cited
CCR
101238(a)
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Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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Per Director, will contact an electrician to have key pad repaired, will submit proof of corrections by 07/31/2019.
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The requirement was not met as evidence by LPAs was able to gain access to the facility through the unlocked front door. This facility is located next to a high traffic street with a homeless population wandered nearby. This poses an immediate risk to the health and safety of 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
LIC9099 (FAS) - (06/04)
Page: 4 of 5