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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494263
Report Date: 12/22/2021
Date Signed: 12/22/2021 01:18:22 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2021 and conducted by Evaluator Denise Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20211104150905
FACILITY NAME:MAPLE TREE ACADEMY WLA-INFANTFACILITY NUMBER:
197494263
ADMINISTRATOR:STEPHANIE CHACON MEDINAFACILITY TYPE:
830
ADDRESS:2920 S SEPULVEDA BLTELEPHONE:
(310) 314-1111
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:70CENSUS: 28DATE:
12/22/2021
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Stephanie Chacon, Director TIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff inappropriately changes day care children's diapers.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/22/2021 at 12:35PM, Licensing Program Analyst (LPA) Denise Miranda conducted a visit at 2920 Sepulveda Blvd, Lo Angeles, CA 90064, for the purpose of delivering the investigation finding for the above-mentioned allegation. Upon arrival, LPA Miranda met with Stephanie Chacon Director and informed the purpose of the visit.
There are 14 infants and 14 toddlers and 7 staff and Director present at the faciltiy. LPA observed 2 teachers providing care and supervision for 7 infants while they are sleeping and 2 teachers with 6 infants (Music room/not napping) and 2 teachers with 14 toddlers during sleeping time.
Based on the informastion gathered throughout the course of the investigation which include LPA observation and interviews, the allegation above is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or are valid, there are not a preponderance of the evidences to prove that the alleged violation occurred.
An exit interview was conducted, and a copy of this report along with appeal rights was provided to Stephanie Chacon Medina, Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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