Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018831
Report Date: 11/09/2016
Date Signed 11/09/2016 02:03:19 PM

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:MARIANA VITELAFACILITY TYPE:
850
ADDRESS:311 S. NORMANDIE AVE.TELEPHONE:
(213) 365-0909
CITY:LOS ANGELESSTATE: CAZIP CODE:
90020
CAPACITY:63CENSUS: DATE:
11/09/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angie Gomez TIME COMPLETED:
02:00 PM
NARRATIVE
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On this date Licensing program analyst Seung Lee conducted an unannounced complaint investigation visit. Upon arrival LPA met with Director Angie Gomez who guided the LPA on a tour of the facility. LPA Lee toured the facility and observed a total of 48 children present today in the facility.

During the tour of the facility it was observed that one classroom had 21 children present with 1 qaulified teacher, 1 qaulified aid, and 1 adult with no units. The director stated normally there are 2 qaulified teachers for this classroom, but one of the teachers is on jury duty on this date. LPA Lee informed the Director the facility must still be in ratio regardless of a teacher being absent or not.

Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.

Whenever a type A is cited:
“Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

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 Director. Appeal rights discussed and explained.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3412
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2016
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2016
Section Cited
101216.3(a)
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Teacher – Child Ratio.

There shall be a ratio of one teacher supervising no more than 12 children in attendance except as specified in (b) and (c). LPA observed one classroom with 21 children and 1 Teacher. There was 1 qaulified aid and 1 adult present
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Director stated that she will comply with the teacher child ratio for title 22 from now on. Director also stated she will make accomadations to stay in ratio even if a teacher is absent or not present. Director stated she is hiring additional staff.
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along with the teacher. This is an immediate 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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3412
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2016
LIC809 (FAS) - (06/04)
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