Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018831
Report Date: 06/02/2017
Date Signed 06/02/2017 03:26:45 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
05/24/2017 and conducted by Evaluator Seung Lee
COMPLAINT CONTROL NUMBER: 33-CC-20170524091225
FACILITY NAME:PINE TREE PRESCHOOLFACILITY NUMBER:
198018831
ADMINISTRATOR:ANGIE GOMEZFACILITY TYPE:
850
ADDRESS:311 S. NORMANDIE AVE.TELEPHONE:
(213) 365-0909
CITY:LOS ANGELESSTATE: CAZIP CODE:
90020
CAPACITY:63CENSUS: 37DATE:
06/02/2017
UNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Angie Gomez TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility in disrepair - peeling paint
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced complaint inspection. Upon arrival LPA Lee met with Director Angie Gomez who guided the analyst on a tour of the facility.

During today's inspection LPA Lee inspected all the classrooms, restrooms, and kitchen. LPA Lee also interviewed all staff members, including the Director, present today regarding the above allegation.

It was observed that a sink in the girl's restroom is in the process of being replaced. There are some pipes that are exposed. There is a small table that provides a type of cover for these exposed pipes as a temporary fix to the issue . The Director stated a replacement has already been ordered will be installed by Monday June 5th 2017.

Although the pipes are not sharp and is covered up by a small table, the facility is still currently in disrepair. This is can be a potential risk for children in care.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2017
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 7


Control Number 33-CC-20170524091225

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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2017
Section Cited
101238(a)
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Buildings and Grounds.

The child care center shall be clean, safe, sanitary and in good repair at all times. LPA observed that the there are pipes exposed in the girls bathroom due to a broken sink that was taken out. This is a potential risk to children.
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Director stated the replacement sink will be installed by 6/09/2017. Will provide proof via pictures.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2017
LIC9099 (FAS) - (06/04)
Page: 7 of 7



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
05/24/2017 and conducted by Evaluator Seung Lee
COMPLAINT CONTROL NUMBER: 33-CC-20170524091225

FACILITY NAME:PINE TREE PRESCHOOLFACILITY NUMBER:
198018831
ADMINISTRATOR:ANGIE GOMEZFACILITY TYPE:
850
ADDRESS:311 S. NORMANDIE AVE.TELEPHONE:
(213) 365-0909
CITY:LOS ANGELESSTATE: CAZIP CODE:
90020
CAPACITY:63CENSUS: 37DATE:
06/02/2017
UNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Angie Gomez TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility staff failed to keep the facility free of insects and/or rodents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced complaint inspection. Upon arrival LPA Lee met with Director Angie Gomez who guided the analyst on a tour of the facility.

During today's inspection LPA Lee inspected all the classrooms, restrooms, and kitchen. LPA Lee also interviewed all staff members, including the Director, present today regarding the above allegation.

During the inspection LPA observed no insects or rodents at the facility. LPA Lee observed the floor near the trashcan and corners of each classroom. There were no signs of insects and or rodents. A few staff memebers did state that they have seen insects inside the facility on one or two occassions in the past. No staff disclosed that they ever seen rats inside the facility. The only rats or rodents that were observed was outside near the edge or the property by the fences/gate.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7



Control Number 33-CC-20170524091225
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: 06/02/2017
NARRATIVE
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The cleaning lady for the facility is a paid employee of the school. Her normal hours are 6pm-11pm according the Director. The Director stated that the cleaning lady speaks only Spanish and has never observed parents talking to this cleaning lady ever.

LPA Lee obtained several documents that verify the cleaning lady's employment and regular hours from the Director.

The Director stated that a pest control company comes out to the facility once a month. LPA Lee obtained a copy of the invoice for services provided in May and April of 2017. The invoice is from a pest control company called Orkin. According to the Director the company uses non hazardous chemicals when it comes sanitizing the facility which has been confirmed by the details of the work order.

Although a staff members did state they have seen insects inside the facility in the past, LPA observed no insects or rodents and the rest of the staff stated they have never seen insects inside the facility.

Therefore, 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 unsubstantiated

Exit Interview conducted with Director Angie Gomez. Appeal rights discussed and explained.

SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2017
LIC9099 (FAS) - (06/04)
Page: 6 of 7



Control Number 33-CC-20170524091225
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: 06/02/2017
NARRATIVE
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Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of the evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3 (FCC) (1 DCC) number) are being cited on the attached LIC9099D

Exit Interview conducted with Director Angie Gomez. Appeal rights discussed and explained.

SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2017
LIC9099 (FAS) - (06/04)
Page: 2 of 7