198008421-1-14-2020-33-CC-RLOZ-BKTVGZ-20200114152622

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198008421
Report Date: 01/14/2020
Date Signed: 01/14/2020 03:26:32 PM

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:	MAPLE AVE. AFTER SCHOOL EDUCATION CENTER		FACILITY NUMBER:	198008421
ADMINISTRATOR:	CHUANG, LINDA		FACILITY TYPE:	840
ADDRESS:	320 N. MAPLE AVE.		TELEPHONE:	(323) 724-8181
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	25	CENSUS: 0	DATE:	01/14/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Irene Lopez		TIME COMPLETED:	03:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Roxana Lopez and Ariel Cazares conducted an Annual Required inspection at this facility. LPA met with Irene Lopez, Assistant Director, who guided analysts on tour of the facility indoors and outdoors. This is an after-school program offered to school-age children. Hours of operation are from 7AM-6PM. Per Assistant Director children are in the facility from 7:00 am- 8 :00 am and from 3:00 pm- 6:00 pm. They also have an extended all day program during winter, summer and spring, (when regular school is not in session) from 7AM – 6PM. Facility is two stories, it consists of a multi-purpose room, homework area, main classroom, one children's restroom, kitchen, staff restroom and fenced backyard. The off limit areas for children include the upstairs room, which is licensed but it is not used due to low enrollment. LPA's observed a leak in the upstairs room, this room is off limits for children in care. Per Ms. Lopez an order was placed to have the leak repaired. Children will not use this area until repairs are done. At time of LPA's arrival there were no children present. Per Director, there are currently 25 children enrolled in the program. Furniture and equipment were inspected and are safe and in good repair. There is telephone landline service at the facility. Heating/Air, lighting and ventilation were evaluated. At this time, the Director’s office is used as an isolation area. There is a mat available if needed. There is drinking water both indoors and outdoors. Restroom used by children were inspected for availability, good repair, toilet paper, soap, safety and sanitation. ----------------------------------------------------- Page 1 of 2 --------------------------------------------------------------------------

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: MAPLE AVE. AFTER SCHOOL EDUCATION CENTER	FACILITY NUMBER: 198008421
	VISIT DATE: 01/14/2020

NARRATIVE

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Snack menus were posted in the classroom and are provided to the parents a month in advance. Snack menus were reviewed and snacks were reviewed for availability, quantity and appropriateness to children in care. The facility provides a PM snack. When participants are in the holiday extended program then parents will provide lunch and facility will provide a snack. All cleaning compounds were observed to be inaccesible.

No medication is provided at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301.

Children’s Records were reviewed for completeness; Inspection of required forms was made. Criminal Records Clearance for adults, Assistant Director is CPR trained with expiration date of 04/20/21. No staff files were available for review.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Please see 809D for deficiencies cited.

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 reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview conducted with Irene Lopez, copy of report given. A copy of this report and appeals rights were provided and explained.

--------------------------------------------------------------End Report------------------------------------------------------------------

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MAPLE AVE. AFTER SCHOOL EDUCATION CENTER	FACILITY NUMBER: 198008421
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/21/2020 Section Cited	1 2 3 4 5 6 7	101217(a) Personnel Records- The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement has not been met by no staff files available for LPA's review. This poses a potential risk for the health and safety of 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.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3