197419436-10-3-2024-58-CC-RRAS-D9WVHK-20241010162717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197419436
Report Date: 10/03/2024
Date Signed: 10/03/2024 10:05:44 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/16/2024 and conducted by Evaluator Elicia Calvillo

COMPLAINT CONTROL NUMBER: 58-CC-20240716104149

FACILITY NAME:	LITTLE TREEHOUSE ACADEMY		FACILITY NUMBER:	197419436
ADMINISTRATOR:	ANNA SHIROKOVA		FACILITY TYPE:	830
ADDRESS:	18510 PLUMMER STREET		TELEPHONE:	(818) 772-9320
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	18	CENSUS: 8	DATE:	10/03/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Anna Shirokova, Director		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in day care child
sustaining unexplained injuries.

Staff did not provide responsible party with incident report.

INVESTIGATION FINDINGS:

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n 10/03/2024 at 09:20 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegations. LPA identified self and met with Anna Shirokova, Director, who allowed entry into the facility and provided LPA a guided tour of the inside and outside of the facility. Upon arrival there were 8 children and 2 staff present.

During today’s visit, LPA addressed the allegations that staff did not provide adequate supervision resulting in day care child sustaining unexplained injuries and staff did not provide responsible party with incident report. Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, interviewed Director, interviewed parents, attempted to interview children, interviewed staff, and reviewed video footage of the classroom and the child care center grounds.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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 58-CC-20240716104149

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LITTLE TREEHOUSE ACADEMY	FACILITY NUMBER: 197419436
	VISIT DATE: 10/03/2024

NARRATIVE

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Information provided by the Reporting Party (RP) indicates that staff did not provide adequate supervision resulting in day care child sustaining unexplained injuries and staff did not provide responsible party with incident report.

Director disclosed that there have not been any children who have sustained an injury in a classroom that was not reported to their parent. If a child is injured in the classroom staff will follow the child care center procedure; staff will attend to the child, notify the Director, complete an incident “Ouchy” report, and notify the parent.

When interviewing staff, no staff disclosed that any child sustained an injury when in the classroom and if a child sustains an injury, they will follow the child care center procedure; attend to the child, notify the Center Director, complete an incident “Ouchy” report, and notify the parent.

When interviewing parents, no parents disclosed that when a child sustains an injury they are never notified of the injury or have never resolved a child’s injury with the child care center.

No children made disclosures due to the age of the children.

Based on LPA’s observations and interviews which were conducted and record review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Anna Shirokova, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC9099 (FAS) - (06/04)

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