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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419435
Report Date: 12/22/2023
Date Signed: 12/22/2023 01:01:02 PM

Document Has Been Signed on 12/22/2023 01:01 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LITTLE TREEHOUSE ACADEMYFACILITY NUMBER:
197419435
ADMINISTRATOR:ANNA SHIROKOVAFACILITY TYPE:
850
ADDRESS:18510 PLUMMER STREETTELEPHONE:
(818) 772-9320
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 14DATE:
12/22/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Anna Shirokova, DirectorTIME COMPLETED:
12:55 PM
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On 12/22/2023 at 9:55 AM, Licensing Program Analyst (LPA) Elicia Calvillo and Licensing Program Manager (LPM) Rita Ramos met with Facility Representative (FR) Anna Shirokova. LPA and LPM announced the purpose of the visit was to conduct a required 3 Year Inspection to ensure the health, safety, and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. The Entrance Checklist was provided to the Facility Representative upon entrance.

Facility Representative Anna Shirokova, Director allowed entry to facility and provided LPA and LPM on a guided tour of both indoors and outdoors. Facility is currently licensed for a capacity of 85, per FR they currently have 37 enrolled. The program currently operates Monday thru Friday from 8:00 AM to 5:00 PM. Required postings were observed posted in lobby and in each classroom.

The facility is made up of three preschool classrooms: RM-1 Large 4 years with 1 staff and 8 children, consist of two areas and half of the room is empty and licensee has a divider due to low enrollment. RM-2 no staff or children, RM-3 Preschool 3 years with 1 staff and 6 children.

Beginning at 10:00 AM, furniture, toys, and equipment were inspected for age appropriateness and good repair in each classroom. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. LPA and LPM observed standard blue cots stored in each classroom. Per FR, linens are

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LITTLE TREEHOUSE ACADEMY
FACILITY NUMBER: 197419435
VISIT DATE: 12/22/2023
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provided by the families and taken home weekly for washing. Availability of drinking water was observed via sippy cups. Age appropriate sinks and toilets were observed for availability water temperature, toilet paper, area safety and sanitation. While inspecting RM 1 toilet was not flushing, in RM 2 1 toilet had a broken handle, and RM 3 1 toilet was not flushing and there were 3 toilets available for use.

LPA and LPM observed a first aid kit is kept in each classroom and inventoried for necessary supplies. LPA and LPM observed a devise high on the ceiling. Per Licensee, it is a carbon monoxide detector. LPA and LPM observed smoke detector via fire alarm. Disaster drill log was available. Per FR, isolation area for sick children is in the office and if need be, will bring in cot or mat for a child to lay down. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA and LPM observed cleaning solutions stored in high cabinets and high shelves in classrooms.


Beginning at 10:30 AM, outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade is provided by trees and fencing was observed. LPA and LPM observed each play area to have shade available. The children have access to drinking fountains during outside play, per FR drinking fountains are used only to refill children's water bottles. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water observed.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA and LPM observed 14 of 37 children signed in at time of inspection. Personal Rights of children were observed by LPA and LPM.

At 10:05 AM, food preparation areas were toured for safety, cleanliness and proper equipment. Snack/lunch menus were reviewed and observed posted in each classroom. Facility prepares food for children. At 10:05 AM, LPA and LPM observed an uncleared adult, Staff #3, preparing food in the Kitchen. Per Director, Staff #3 is the cook and does not work with children. LPM and LPA observed that Staff #3 has to enter Room 1 in order to go to the kitchen and is an employee at the facility. LPA and LPM discussed observation

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LITTLE TREEHOUSE ACADEMY
FACILITY NUMBER: 197419435
VISIT DATE: 12/22/2023
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with FR at time of inspection. Per FR, individual has been present since August of 2023. A civil penalty of $100 is being assessed during today's visit. LPA and LPM discussed below requirement.

Facility representative Anna Shirokova, Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated
.

Beginning at 10:50 AM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. Criminal Record Clearances were reviewed for adults. CPR card expires on 09/2025 for Staff #1. Staff files reviewed did have proof of the AB 1207 Mandated Reporter Training certificate on file. Inspection of required forms were discussed.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
LPA and LPM verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LITTLE TREEHOUSE ACADEMY
FACILITY NUMBER: 197419435
VISIT DATE: 12/22/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02 -CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Anna Shirokova was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The following deficiencies are being cited on the deficiencies page.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Anna Shirokova, Director.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
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Document Has Been Signed on 12/22/2023 01:01 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 12/22/2023 at 12:25 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LITTLE TREEHOUSE ACADEMY
FACILITY NUMBER: 197419435

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was nit met as evidenced by Staff # 3 being present, employed, and having access to children in care which poses an immediate health, safety, and personal rights to children in care,
POC Due Date: 12/26/2023
Plan of Correction
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Per Director, Staff #3 will be fingerprinted by POC due date,
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023


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