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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419436
Report Date: 04/17/2023
Date Signed: 04/17/2023 11:34:01 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2023 and conducted by Evaluator Doris Whitmore
COMPLAINT CONTROL NUMBER: 58-CC-20230123122539
FACILITY NAME:LITTLE TREEHOUSE ACADEMYFACILITY NUMBER:
197419436
ADMINISTRATOR:ANNA SHIROKOVAFACILITY TYPE:
830
ADDRESS:18510 PLUMMER STREETTELEPHONE:
(818) 772-9320
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:18CENSUS: 4DATE:
04/17/2023
ANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Anna ShirokovaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
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9
Other
INVESTIGATION FINDINGS:
1
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13
On 01/26/2023 Licensing Program Analyst Doris Whitmore met with Anna Shirokova Director, LPA observed a total of one teacher and two infants. LPA toured the facility indoors and outdoors, observing proper teacher/child ratios with 2 infants in care. LPA obtained the following documents Personnel Report, Safe Feeding Practices to Prevent Choking handout, First Aid& CPR Certificates, Mandated Reporter General Training Certificate, Illness Form. Employee Development on Supervision & Staff in Service Training, Parent Consent for administration of medication & other documentation pertaining to this investigation. Based upon information obtained and interviews conducted the allegation that staff does not all ow authorized representatives to inspect facility deemed unsubstantiated. Meaning although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interview was conducted, a copy of this report, appeal rights and Notice of Site Visit were issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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