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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371252
Report Date: 04/09/2021
Date Signed: 04/09/2021 03:16:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2020 and conducted by Evaluator Jordann Nelson
COMPLAINT CONTROL NUMBER: 06-CC-20201021140406
FACILITY NAME:APPLE TREE PRESCHOOL & KINDERGARTENFACILITY NUMBER:
304371252
ADMINISTRATOR:ANTONY, HARSHIFACILITY TYPE:
850
ADDRESS:2211 WEST WOODLEY AVENUETELEPHONE:
(714) 403-8837
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:60CENSUS: 48DATE:
04/09/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marben PeranculloTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is operating over capacity.
INVESTIGATION FINDINGS:
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Tele-Inspection-COVID 19 State of Emergency

On 04/09/2021 Licensing Program Analyst (LPA) Jordann Nelson conducted an announced complaint Tele-Inspection regarding the allegation listed above with director Marben Perancullo. The director was informed that due to COVID-19 and social distancing guidelines, the visit would be conducted via Facetime.

A review of staff personnel roster (LIC 500) obtained an reviewed indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. There were 48 children in care with 5 attending staff.

The department received a complaint that the facility is operating over capacity. Interviews were conducted with the facility owner, director, five teachers and three parents.
continued on page 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 06-CC-20201021140406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 304371252
VISIT DATE: 04/09/2021
NARRATIVE
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continued from page 1

During the investigation LPA Nelson reviewed the daily child logs of children who attend the school. LPA Nelson reviewed and obtained sign in and sign out roster (June-October 2020) for the four-year-old classroom. LPA Nelson interviewed five teachers; four teachers disclosed that the daily child log is not accurately reflecting the child census in the four-year-old classroom. During the interview process two teachers confirmed that they have been over capacity on various days including 10/14/2020 and on 04/02/2021.

In the four-year-old classroom on 10/14/2020 there were 13 children and on 04/02/2021 there were 14 children in the four-year-old classroom, this was confirmed by interviews and LPA Nelson’s review of the sign in and sign out sheet for the four-year-old classroom. Based on interviews conducted, when more children arrived at school though out the morning, the director moves the children into preschool classrooms where there is a lower child census. The children are moved to another classroom even if it’s not the child assigned teacher. Interviews were conducted with licensee Harshi Antony, LPA inquired if she was aware about the capacity issue, interviews confirmed that no concerns were brought to the licensee attention.

LPA Nelson reviewed the daily child logs and the sign in sheet for 10/14/2020 and 04/02/2021 there were 13 children in the four-year-old classroom, but the five-year-old class room only had nine children so two of the four year old children were moved over to the five year old classroom on that day.

continued on page 3.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20201021140406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 304371252
VISIT DATE: 04/09/2021
NARRATIVE
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continued from page 2


On 04/02/2021 there were 16 children on the four-year classroom roster 14 children were in attendance, two children were moved to the five-year-old classroom. Interviews with the center director confirmed that on various occasions, due to not having enough teachers, the director will move children out of the over capacity classroom to the lower capacity classroom.

LPA interviewed three parents none of the parents expressed concerns regarding classroom being over capacity.

Based on California Code of Regulations, Title 22, Division 12 Chapter 1 101216.3 Teacher-Child Ratio The teacher to child ratio was 1:13 on 10/14/2020 and 1:14 on 04/02/2021 two verifiable occasions, which poses an immediate health and safety risk to the children in care. Please refer to LIC 9099-D. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

End of Report


























SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20201021140406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 304371252
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/09/2021
Section Cited
HSC
101216.3(a)
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Teacher Ratio There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance except as specified in (b) and (c) below. This was not met as evidence by...
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The facility director will ensure that the ratio of 1:12 is in place at all times in all classrooms.
Staffing ratios need to be in place ensuring the health and saftey of all children in care. The center director will devise a plan to ensuring that the staffing ratios will be met and submit to CCL by 04/12/2021.
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Based on interviews and record review of child daily logs. The teacher to child ratio was 1:13 on 10/14/2020 and 1:14 on 04/02/2021 two verifiable occasions This is an immediate health and saftey risk for the children 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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4