Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018831
Report Date: 11/09/2016
Date Signed 11/09/2016 02:04:36 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2016 and conducted by Evaluator Seung Lee
COMPLAINT CONTROL NUMBER: 33-CC-20161007100104
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
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is out of ratio.
INVESTIGATION FINDINGS:
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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.

LPA Lee reviewed the sign in sheets and time cards provided by the director on the previous visit made on 10/14/2016. The facility was in ratio when LPA Lee was present on 10/14/2016. There is nothing on the time card or sing in sheets that directly proves that the facility was out of ratio on 10/14/2016 or a week prior. The Director denied the allegation, and staff members interviewed made no disclosure.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore at this time the above allegation is inconclusive.
Inconclusive
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2



Control Number 33-CC-20161007100104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/09/2016
NARRATIVE
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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
LIC9099 (FAS) - (06/04)
Page: 2 of 2