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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020251
Report Date: 08/15/2024
Date Signed: 08/15/2024 02:35:31 PM

Document Has Been Signed on 08/15/2024 02:35 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 PRESCHOOLFACILITY NUMBER:
198020251
ADMINISTRATOR/
DIRECTOR:		MALI RANDFACILITY TYPE:
850
ADDRESS:1423 TAMARIND AVETELEPHONE:
(323) 469-3706
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 38DATE:
08/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Mali Rand, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
NARRATIVE
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On August 15, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Priscilla Ochoa conducted an unannounced case management inspection at the above facility. The purpose of the visit is to provide the director with an Amended complaint report indicating that the findings have been changed from unfounded to substantiated (see complaint reported dated 07/23/2024). A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with director, Mali Rand who guided LPAs on a tour of the facility. LPAs 38 observed children in care.

The facility is being cited a Type B deficiency for the amended complaint report dated 07/23/2024. The complaint report was amended on 08/15/2024.

An exit interview was conducted and a copy of this report was provided to the director, Mali Rand 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: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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 08/15/2024 02:35 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 08/15/2024 at 01:52 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
FACILITY NUMBER: 198020251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2024
Section Cited
CCR
101218.1(b)(4)

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Admission Procedures and Parental and Authorized Representative's Rights: At the time of acceptance of each child in care, the licensee shall inform each child's parent or authorized representative of his/her rights that include... To review at the child care center, reports of licensing visit and
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Director will ensure that all families have a received a copy of the substantiated complaint and have signed the LIC9224.
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substantiated complaints against the licensee. This requirement was not met as evidence by: Based on interviews and record review, Parent #1 stated she did not receive the substantiated complaint and LPA did not observe a signed LIC9224 in child's file. This poses a potential health and safety risk to 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: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
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