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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371253
Report Date: 03/26/2021
Date Signed: 03/26/2021 12:00:01 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
10/16/2020 and conducted by Evaluator Jordann Nelson
COMPLAINT CONTROL NUMBER: 06-CC-20201016163749
FACILITY NAME:APPLE TREE PRESCHOOL & KINDERGARTENFACILITY NUMBER:
304371253
ADMINISTRATOR:ANTONY, HARSHIFACILITY TYPE:
830
ADDRESS:2211 WEST WOODLEY AVENUETELEPHONE:
(714) 403-8837
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:30CENSUS: DATE:
03/26/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Marben Perancullo DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Parent noticed bitemarks and scratches on her child's arms and legs.
INVESTIGATION FINDINGS:
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Tele-Inspection-COVID 19 State of Emergency
On 03/26/2021 Licensing Program Analyst (LPA) Jordann Nelson conducted an announced complaint Tele-Inspection regarding the allegation listed above with Marben Perancullo. The licensee was informed that due to COVID-19 and social distancing guidelines, the visit would be conducted via Facetime.


A review of the Facility Personnel Summary on the above date indicates that all staff have criminal background clearance check clearances and are properly associated to the center. There were 17 children and 4 staff in attendance. The department received a complaint alleging that a parent noticed bitemarks and scratches on the child's arms and legs.


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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 06-CC-20201016163749
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: 03/26/2021
NARRATIVE
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During the investigation, LPA Nelson reviewed ouch reports, children were observed at the daycare center during normal operating hours. Four children and five facility staff along with two parents were interviewed.

Interviews were conducted with three teachers, owner and the director. The director and the owner both acknowledge that a child in question was having behavior episodes and was biting children in care. Interviews were conducted with the three center teachers who confirmed that the child in question would target children with toys or items that the child in question wanted. The child in question would act out by biting children they wanted the toys from. LPA obtained clarification from the complainant, that bite marks appeared as bite scratch markings on the children’s hands. Interviews with teachers, director, owner and parents confirmed that scratch marks were not present. LPA reviewed the ouch reports they did not mention scratches.

Interviews were conducted with two parents whose children were bitten by the child in question who was acting out, the parents confirmed that the bite marks were located on their children. Interviews were also conducted with three children who were bitten by child in question. Ouch reports were reviewed and confirmed three biting incidents among three separate children. Interviews were conducted with two parents who stated that they spoke with the center director to ensure that supervision is always in place.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20201016163749
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: 03/26/2021
NARRATIVE
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Based on interviews conducted and review of ouch reports the licensee failed to ensure supervision was always in place to ensure the safety of the children, therefore, the preponderance of evidence standard has been met, and the above allegation is found to be substantiated. California Code of regulations, Title 22, Division 12, 101229 Responsibility for Providing Care and Supervision is being cited on the attached LIC 9099D.

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.


Exit interview was conducted with Marben Perancullo via Tele-Inspection. Report was read to Director. A copy of the report along with Appeal Rights will be emailed to Licensee with a Read Receipt to acknowledge report was received. Director was asked to respond to email by copying the following, “I have read and received the Investigation Report and Appeal Rights, I acknowledge receipt.” All appeals must be in writing and received by the Licensing office within 15 business days. End of report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20201016163749
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/26/2021
Section Cited
HSC
101229(a)
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Responsibility for Providing Care and Supervision:101229 (a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This was not met as evidence by
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The facility director will develop trainning with staff to identify any child who may exhibit biting behaviors so they cannot injure other chldren-by having additonal staff or spacing for children when activities occur. The plan should be submitted to CCL by 03/29/2021.
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Based on interviews and ouch reports the Licensee failed to prevent three episodes of biting by a child in care which resulted in three children being bitten. This is an immediate health and safety risk.

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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4