197492821-9-1-2022-30-CC-LJCS-CHUV7F-20220901161103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197492821
Report Date: 09/01/2022
Date Signed: 09/01/2022 04:11:09 PM

Document Has Been Signed on 09/01/2022 04:11 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MAPLE TREE		FACILITY NUMBER:	197492821
ADMINISTRATOR:	YOLANDA SANCHEZ		FACILITY TYPE:	830
ADDRESS:	1814 14TH STREET		TELEPHONE:	(310) 314-1111
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	40	CENSUS: 30	DATE:	09/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yolanda Sanchez		TIME COMPLETED:	01:30 PM

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On 9/1/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Annual Required Inspection for the infant license. LPA met with Director, Yolanda Sanchez, and Director of the preschool license (#197492822), Tina Colombel. LPA toured the indoor and outdoors of the facility. Days and hours of operation are Monday through Friday, 7:30am to 5:30pm.

The infant center is located on the first floor. LPA observed two doors that lead to infant center spaces. Director explained these doors are locked between 9:00am and 3:00pm. LPA walked down a hallway to enter the modified indoor space for outdoor activities. Upon entering this area, LPA observed a bathroom with 1 toilet, 1 sink, 2 children's potties, and 1 changing table. The modified indoor space is is divided into 3 sections, and infants use the section with matted flooring, 1 climbing structure, 1 couch, 1 changing table, and 1 sink. The indoor includes 1 kitchen, 1 napping room, and 1 large room divided into spaces for mobile and non-mobile infants. LPA observed infant mirrors, tables, and age-appropriate toys. In the napping room, LPA observed 14 cribs. Each crib or mat is occupied by only one infant at time, and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Infants up to 12 months of age are placed on their backs for sleeping. LPA observed staff-infant ratio requirements are being met while infants are sleeping. Facility demonstrated a sample of 15 minute infant sleeping logs. The kitchen is clean and organized. LPA observed 3 refrigerators to store individual cubbies, 1 sink, and 2 children's tables with age-appropriate chairs.

LPA reviewed a sample of 10 children’s files and observed files were complete, including the LIC 9227 Individual Infant Sleeping Plan, individual feeding plan, and Infant Needs and Services Plan. LPA reviewed a sample of staff files and observed files were complete. Staff records contain documentation of meeting infant qualification requirements. All staff are trained in CPR and Pediatric First Aid. There is a ratio of one teacher supervising no more than four infants in care. The name of the child care center director or or fully-qualified

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAPLE TREE	FACILITY NUMBER: 197492821
	VISIT DATE: 09/01/2022

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teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

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

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Tina Colombel.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC809 (FAS) - (06/04)

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