197419436-10-23-2024-58-CC-ECAO-DABUNN-20241023154413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419436
Report Date: 10/23/2024
Date Signed: 10/23/2024 03:44:21 PM

Document Has Been Signed on 10/23/2024 03:44 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 ACADEMY		FACILITY NUMBER:	197419436
ADMINISTRATOR/ DIRECTOR:	ANNA SHIROKOVA		FACILITY TYPE:	830
ADDRESS:	18510 PLUMMER STREET		TELEPHONE:	(818) 772-9320
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY: 18	TOTAL ENROLLED CHILDREN: 7	CENSUS: 6	DATE:	10/23/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:18 AM
MET WITH:	Anna Shirokova, Director		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/23/2024 at 09:18 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Annual Required Inspection. Facility is located at 18510 Plummer Street, Northridge, CA. 91324. LPA identified self and met with Anna Shirokova, Director, LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection. Facility Representative (FR) Anna Shirokova, Director allowed entry to facility and provided LPA a guided tour of inside and outside of the facility. The facility is currently licensed for a capacity of 18, per FR they currently have 7 enrolled. The facility hours of operation are currently Monday thru Friday from 08:00 AM to 05:00 PM. Required postings were observed posted in Main Office. The facility is made up of 4 classrooms and 1 classroom is used for Infants 12 months to 24 months, with 2 staff and 1 floater staff. Beginning at 09:30 AM, LPA observed the following in the classroom. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were cubbies used for each child to store their belongings. Drinking water was readily available with individual sippy cups and pitcher of water is available in the classroom to refill the individual sippy cups. Currently, the children in the Infant room are not potty trained and there was a changing table with a sink within arms distance and soiled diapers are in airtight containers located outside the classroom door. There are restrooms available for potty training, the restroom(s) were inspected for safety and sanitation. There were age-appropriate sinks and toilets located in classroom and there was available water, water temperature was appropriate, toilet paper was provided. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort. PAGE 1 OF 4

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: 197419436
	VISIT DATE: 10/23/2024

NARRATIVE

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LPA observed a first aid kits located in the classroom and inventoried for necessary supplies. LPA observed a device in the classroom, per FR it is a carbon monoxide detector. LPA observed smoke detector via fire alarm. Disaster drill log was available, and the last disaster drill was conducted on 10/17/2024. Per FR, isolation area for sick children is in the office. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA observed cleaning solutions stored in a high cabinet.

Beginning at 09:45 AM, LPA did observe the kitchen area/ food preparation area, per FR snacks and meals are provided by the facility. Snack and meal menus are posted in each classroom. LPA did not observe any open containers in the refrigerator. Food preparation was inspected for safety and sanitation, hazardous items including poisonous cleaning compounds were stored inaccessible to children with the use of door lock to the kitchen.

Beginning at 10:00 AM, LPA toured the outdoor play area and observed playground equipment in safe conditions, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is adequate shade in the play yard. The children have access individual sippy cups, a pitcher of water for refills, and a water fountain for drinking water during outdoor play. LPA advised that no children shall be left without the supervision at any time. There is no swimming pool or other bodies of water on the premises.

Beginning at 10:15 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. LPA’s record review of the children’s files found 2 of 5 files did not contain the LIC 700 Physician’s Report readily available upon request. Criminal Record Clearances were reviewed for adults. CPR card expires on 07/2026 for Director. Inspection of required forms were discussed.

LPA observed that teacher-child ratios were maintained, and staff names were 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 observed 6 of 6 children signed in at time of inspection. Personal Rights of children were observed by LPA.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 197419436
	VISIT DATE: 10/23/2024

NARRATIVE

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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/.

For IMS information see PIN 22-02-CCP. 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/.

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 verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Facility Representative 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.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 197419436
	VISIT DATE: 10/23/2024

NARRATIVE

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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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are being cited.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Anna Shirokova, Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4