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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019281
Report Date: 11/14/2024
Date Signed: 11/14/2024 05:19:10 PM

Document Has Been Signed on 11/14/2024 05:19 PM - It Cannot Be Edited

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:HAPPY BIRCH PRESCHOOL- TAMARINDFACILITY NUMBER:
198019281
ADMINISTRATOR/
DIRECTOR:		SOLEDAD GUEVARAFACILITY TYPE:
850
ADDRESS:1429 TAMARIND AVETELEPHONE:
(323) 380-7311
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 36DATE:
11/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Mali Rand, DirectorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On November 14, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Mariah Aguirre conducted an unannounced Case Management inspection at the above facility. The facility reported an incident report on 11/04/2024 for an incident that occurred on 11/01/2024. The incident is a possible personal rights violation. LPAs met with director, Mali Rand who guided LPAs on a tour of the facility. LPA observed 36 children present.

During the inspection, LPAs observed a Staff #4 (S4) member outside with 13 children at 8:52AM and at 8:53AM, LPAs observed 2 additional children arrive. At 8:53AM there was a total of 15 children in the rear play ground with S4. The lead teacher was not in rear play ground as she was greeting children at the front gate. LPAs informed director that although there are 2 staff assigned to the classroom, the classes must remain in compliance at all times to ensure children are being supervised.

LPA's interviewed Child #1 (C1) to Child #2 (C2), Staff #1 (S1) to Staff #3 (S3), LPAs obtained a current facility roster and obtained records of the incident from 11/01/2024.

During interviews with S2 it was disclosed that an incident with S3 was observed where C1's personal rights were violated. LPAs observed video footage surveillance of C1 and S3 on 11/01/2024 starting at 11:10AM to 11:14AM and observed S3 restraining C1 on her lap and observed C1 pulling away, yelling and crying. LPAs reviewed video footage surveillance of S3 and C1 on 11/01/2024 at 11:18AM where C1 was starting to play and S3 grabbed C1 by the upper left arm and placed back on S3 lap, there was no restrain. C1 sat on S3 lap until 11:26AM. S3 stood up and held C1 to address another child outside of the camera footage.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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Document Has Been Signed on 11/14/2024 05:19 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 11/14/2024 at 03:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY BIRCH PRESCHOOL- TAMARIND
FACILITY NUMBER: 198019281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/02/2024
Section Cited
CCR
101216.3(a)

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Teacher-Child Ratio: There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance... This requirement was not met was evidence by: Based on LPAs observation, Staff #4 ws observed to be alone with 15 children. This poses an
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Director will watch CCLD videos on ratio and submit a written report on how the facility will ensure teacher-child ratios.
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immediate health and safety risk for children in care.
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Type A
12/02/2024
Section Cited
CCR101223(a)(3)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to...
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Director will watch CCLD personal rights video along with all staff members and submit a written report on what the staff learned and will implement in their daily activites.
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This requirement was not met as evidence by: Based on interviews and video footage surveillance, S3 restrained C1 for approximately 4 minutes, grabbed C1 by the upper left arm and C1 was placed back on S3 lap. This poses an immediate health and safety risk for 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:Ana Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


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: HAPPY BIRCH PRESCHOOL- TAMARIND
FACILITY NUMBER: 198019281
VISIT DATE: 11/14/2024
NARRATIVE
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Based on LPAs observations, interviews and video footage surveillance the facility is being cited two Type A deficiencies in accordance with Title 22 Regulations, see LIC809D.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form (LIC9224) during this visit. A copy of the Parent Notification Requirements was also provided to the Director

LPA informed director that an informal will be held at the Monterey Park Regional Office at a later date.

An exit interview was conducted and a copy of this report was provided along with Appeal Rights. A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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