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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419436
Report Date: 03/19/2024
Date Signed: 03/19/2024 01:51:33 PM

Document Has Been Signed on 03/19/2024 01:51 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:
197419436
ADMINISTRATOR:ANNA SHIROKOVAFACILITY TYPE:
830
ADDRESS:18510 PLUMMER STREETTELEPHONE:
(818) 772-9320
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 6DATE:
03/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Anna Shirokova, DirectorTIME COMPLETED:
01:40 PM
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On 03/19/2024, Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced case management inspection for the purpose of citing deficiencies observed during a complaint investigation for Complaint Control Number 58-CC-20231222085410. LPA met with Director, Anna Shirokova, and explained the purpose of the visit. During today’s visit, there were two staff providing care to six infants. During the complaint investigation LPA obtained a copy of the camera footage and conducted interviews. When LPA reviewed the video footage provided, an infant was observed in the preschool playground commingled with preschool children at pickup time. The director explained that because the child was turning two years old in two days, they wanted the child to begin experiencing the interaction with those children to ensure the transition from infant to pre-school is easier.
The following Type B deficiency is being cited on 03/19/2024 in accordance to Title 22 of the California Code of Regulations:
101161 Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

A copy of this Report (LIC809 and LIC809-D), Notice of Site Visit, and Appeal Rights (LIC 9058), was provided and explained to Anna Shirokova, Director.
Exit interview conducted with Director Anna Shirokova
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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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Document Has Been Signed on 03/19/2024 01:51 PM - It Cannot Be Edited


Created By: Silva Garibyan On 03/19/2024 at 12:08 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: 197419436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2024
Section Cited
CCR
101161(a)

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101161 Limitations on Capacity
A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This Requirement is not met as evidenced by:
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Director agrees to provide written plan of how the facility will maintain infant and preschool separate during hours of operation at all times.
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One infant was observed commingled with preschool children on the preschool playground which poses a potential Health or Safety, or personal rights risk to persons 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:Betty Bell
LICENSING EVALUATOR NAME:Silva Garibyan
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024


LIC809 (FAS) - (06/04)
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