197494264-12-22-2021-30-CC-CESO-CAB2WW-20220102164610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494264
Report Date: 12/22/2021
Date Signed: 12/22/2021 02:27:34 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-20211104145715

FACILITY NAME:	MAPLE TREE ACADEMY WLA PRESCHOOL		FACILITY NUMBER:	197494264
ADMINISTRATOR:	AMY SICILIANO		FACILITY TYPE:	850
ADDRESS:	2920 S SEPULVEDA BLVD		TELEPHONE:	(310) 314-1111
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	80	CENSUS: 34	DATE:	12/22/2021
		UNANNOUNCED	TIME BEGAN:	01:56 PM
MET WITH:	Amy Siciliano, Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Personal Rights: Staff inappropriately changes day care children's diapers.

INVESTIGATION FINDINGS:

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On 12/22/2021 at 1:56PM, 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 Amy Siciliano, Director and informed the purpose of the visit. There are 34 children with 7 Staff and Director present at the facility.
Based on the information 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 allegations 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 was provided to Amy Siciliano, Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (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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