Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018831
Report Date: 03/18/2016
Date Signed 03/18/2016 11:00:04 AM

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:PINE TREE PRESCHOOLFACILITY NUMBER:
198018831
ADMINISTRATOR:YANJUN FEIFACILITY TYPE:
850
ADDRESS:311 S. NORMANDIE AVE.TELEPHONE:
(213) 365-0909
CITY:LOS ANGELESSTATE: CAZIP CODE:
90020
CAPACITY:63CENSUS: 58DATE:
03/18/2016
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:YanJun Fei and Champa PereraTIME COMPLETED:
11:00 AM
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A prelicensing site visit was conducted today by LPA Michelle Carter to inspect and measure facility for capacity determination. This is a change of ownership. The new applicant is seeking to provide care for 12 toddlers and 51 preschool children.

LPA met with Applicant YanJun (Anna) Fei of the ZHHL Corporation and Child Care Consultant Champa Perera. The proposed site director Gloria Portillo is already employed at the facility.

There 3 preschool classrooms, Monkey, Bunny and Chipmunks. The preschool children use the restrooms located in the center of the facility. One side is equipped with 2 toilets and 2 sinks, the other side is equipped with 2 toilets, 2 urinals and 2 sinks. The monkey class also is equipped with 2 sinks inside.

The toddlers class, (Dragonflies) has a changing table with arms reach of a sink. There is also a stand alone sink inside the class room. The toddler program has a separate outdoor area from preschool children. The isolation area for an ill child will be in the Directors office. Ill children will use the restroom across the hallway near the toddler entrance.

Medications will be administered with proper authorizations on file. Children who require incidental medical services such as Inhaled medications and epipens will be enrolled. Applicant states there will be an action plan of operation updated in the parent handbook.

Continued on the next page.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3395
LICENSING EVALUATOR NAME: Michelle CarterTELEPHONE: (323) 896-6853
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2016
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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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: PINE TREE PRESCHOOL
FACILITY NUMBER: 198018831
VISIT DATE: 03/18/2016
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According to measurements taken, the facility would require a waiver to provide care for up to 63 children.

The following items are required for Licensure:
1. Revised waiver letters which demonstrates the need for requested capacity.
2. 8 hours preventative health and safety training for Gloria Portillo.
3. Toddler Program requires Admission agreement and needs and services plan for younger children.
4. Criminal record clearance for Applicant YanJun (Anna) Fei.
5. Applicant was advised that parent handbook may need to be revised if capacity request is not approved.

Corrections are due in 30 days. Please contact analyst when all corrections are complete.

* It is recommended that all playgrounds be inspected by an Inspector certified by the National Playground Safety Institute as per provisions of (AB 1055)

An exit interview was conducted with Applicants. Appeal Rights were issued and discussed.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3395
LICENSING EVALUATOR NAME: Michelle CarterTELEPHONE: (323) 896-6853
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2016
LIC809 (FAS) - (06/04)
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