304371253-1-23-2020-06-CC-PMAA-BMB9E3-20200301221737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371253
Report Date: 01/23/2020
Date Signed: 01/23/2020 02:56:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2019 and conducted by Evaluator Andrea Taylor

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20191220150127

FACILITY NAME:	APPLE TREE PRESCHOOL & KINDERGARTEN		FACILITY NUMBER:	304371253
ADMINISTRATOR:	ANTONY, HARSHI		FACILITY TYPE:	830
ADDRESS:	2211 WEST WOODLEY AVENUE		TELEPHONE:	(714) 403-8837
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	30	CENSUS: 19	DATE:	01/23/2020
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Marben Perancullo-Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Infant diaper was wet when picked up at the end of the day on muliple occassions.
Infant had a bottle with spoiled formula

INVESTIGATION FINDINGS:

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The purpose of this inspection was to conduct a Complaint Investigation of the above facility. On 12/20/19 a complaint was filed with the Licensing office. Upon arrival Licensing Program Analyst (LPA) Andrea Taylor met with the director, Marben Perancullo. The census was taken. There were 11 toddler option children with 2 staff members and 8 infants with 2 staff members.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During initial inspection on 12/26/19, LPA Taylor obtained a current infant roster, a current LIC500 Personnel Report, a copy of the current needs and service plans for the infants in the infant classroom and a copy of 12/26/19 daily activity sheets. Prior to inspection LPA reviewed the Diaper Changing Policy. LPA observed diaper changing area and emergency diaper supplies in the infant classroom.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea Taylor	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20191220150127

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN	FACILITY NUMBER: 304371253
	VISIT DATE: 01/23/2020

NARRATIVE

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An allegation of an infant having a soiled diaper on multiple occasions when picked up at the end of the day. No specific dates were given.

During 12/26/19 inspection LPA asked the director about the policy for changing diapers. The director stated the diapers are check every hour or more often and changed as needed. LPA interviewed Staff #1 asking how often diapers are changed. Staff #1 stated the diapers are checked every 30 minutes or more often and changed as needed.

During today’s (1/23/20) inspection LPA interviewed 3 staff out of 3 infant staff. Staff stated the policy for changing diapers is change every 1 to 2 hours but to check the diapers about every 30 minutes and change if needed, all the statements were consistent. Staff stated they are familiar with diaper changing policy and that they follow it. The director goes to the infant room and checks on the diaper changes several times a day.

LPA spoke to 4 out of 6 parents LPA spoke to 4 out 6 parents who stated they do not know what the diaper changing policy is but they do not have any concerns. The parents stated the infants diapers are usually dry when they get there or in the process of being changed. 4 out 6 parents stated their infants have not had a diaper rash.

Based on interviews with 4 staff out or 4 staff, interviews with 4 out of 6 parents, review of infant needs and service plans, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation of not keeping diaper clean and dry did or did not occur, therefore the allegation is unsubstantiated.

An allegation of facility allowed infant, sometime in August 2019, to have a bottle of spoiled formula.

During initial investigation inspection on 12/26/19 LPA Taylor obtained a current children’s roster, a current LIC500 Personnel Report and a copy of the current needs and service plans for the infants, 8 infants out of 8 infants and feeding policy.

Continued on page 3

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea Taylor	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20191220150127

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN	FACILITY NUMBER: 304371253
	VISIT DATE: 01/23/2020

NARRATIVE

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LPA Taylor called 6 parents and spoke to 4 of the 6. All four parents stated they do not know the feeding policy and they do not ever see the infants with bottles outside the feeding area nor have they seen spoiled formula or milk.

During today’s 1/23/20 inspection LPA Taylor interviewed 3 Staff out of 3 Staff, reviewed infant needs and service plans and daily activity forms.
The 3 out of 3 staff interviewed during today's inspection stated the policy for infant’s bottles are the infant's are given bottles every 2 hours and only at the high chair table or in the crib. The 3 out of 3 staff stated the bottles are removed from the crib as soon as the infant falls asleep and if the infant does not finish the bottle the staff wait 15 minutes then dump out the milk or formula. Staff stated every time a child is given a bottle it is freshly made formula or freshly poured milk, never is it left over. All staff statements were consistent.

Based on interviews with 4 staff out of 4 staff, interviews with 4 out of 6 parents and 8 infant needs service plan and review feeding policy, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation of allowing an infant to have a bottle of spoiled formula did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post for 30 day will result in a Civil Penalty of $100.00.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea Taylor	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC9099 (FAS) - (06/04)

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