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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020089
Report Date: 05/12/2021
Date Signed: 05/25/2021 10:09:26 AM

Document Has Been Signed on 05/25/2021 10:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LEARNING TREE MONTESSORI OF ARCADIAFACILITY NUMBER:
198020089
ADMINISTRATOR:CAROLYN MORALESFACILITY TYPE:
850
ADDRESS:9845 E LEMON AVETELEPHONE:
(626) 241-1234
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 120TOTAL ENROLLED CHILDREN: 0CENSUS: 47DATE:
05/12/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Victoria Garcia - DirectorTIME COMPLETED:
01:20 PM
NARRATIVE
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AMENDED REPORT: Non-associated staffs' names were included in report, Jun Ting Huang (S4), Edina Nicolas (S6), and Vania Dzib (S7). Staff start dates: (S4) 04/18/2021, (S6) 03/16/2020, (S7) 05/10/2021. An immediate Civil penalty of $300 was assessed. The attached 809D page has also been amended on 05/25/2021 in order to include the names of the non-associated staff

Licensing Program Analysts (LPA) Nolan Tcheng conducted an unannounced in-person Case Management-Deficiencies inspection. Upon arrival at 9:10am, LPA met with Director Victoria Garcia, to whom the purpose of the visit was explained. At 9:15am, LPA was given a tour of the facility where there were children present at the time of inspection.


Census was taken. There were 2 Staff and 13 Children in Room 1, 2 Staff and 15 Children in Room 3, 2 Staff and 9 Children in Room 5, and 2 Staff and 10 Children in Room 6.

During the walk-through of the facility, LPA observed that Staff #4 (S4), #6 (S6), and #7 (S7) are not associated to the facility. LPA determined through Licensing Information System (LIS) that fingerprints for S4, S6, and S7 are cleared; however, are not associated to the facility. LPA conducted a file review and observed that all necessary documents for associating staff fingerprints are present in S4, S6, and S7's files. LPA discussed with Director the importance of having adults associated to the facility prior to their start date on the property with children. The Department's Guardian system was discussed and copies of licensing forms and photo ID for association were obtained during time of inspection.
The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.Exit interview was conducted with Director Victoria Garcia at 1:05pm, including, but not limited to Provider Rights, Appeal Procedures and Agency’s Consultative Role. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2021
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 05/25/2021 10:10 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/21/2021 11:09 AM


Created By: Nolan Tcheng On 05/12/2021 at 12:45 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LEARNING TREE MONTESSORI OF ARCADIA
FACILITY NUMBER: 198020089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2021
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
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: Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by:
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Director provided LIC508, LIC 9182, and copy of photo ID for Staff #4, #6, #7. Per Director, she will watch the video regarding Background Check Requirements for Caregivers at ccld.childcarevideos.org and will submit a summary of the video to LPA by POC date.
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Based on observation and file review, Licensee did not ensure that Staff #4, #6, #7 had their criminal background clearances associated to the facility prior to working. This poses a potential risk to the health, safety, and personal rights of children in care.
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AMENDED REPORT: Non-associated staffs' names were included in report, Jun Ting Huang (Staff #4), Edina Nicolas (Staff #6), and Vania Dzib (Staff #7). Staff start dates: (S4) 04/18/2021, (S6) 03/16/2020, (S7) 05/10/2021. An immediate Civil penalty of $300 was assessed.

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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:Christina Gabelman
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2021


LIC809 (FAS) - (06/04)
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