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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008421
Report Date: 02/20/2020
Date Signed: 02/20/2020 12:11:44 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 CENTERFACILITY NUMBER:
198008421
ADMINISTRATOR:CHUANG, LINDAFACILITY TYPE:
840
ADDRESS:320 N. MAPLE AVE.TELEPHONE:
(323) 724-8181
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:25CENSUS: 0DATE:
02/20/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Director Linda Chuang TIME COMPLETED:
12:10 PM
NARRATIVE
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At 11;46 am Licensing Program Analysts (LPA’s) Roxana Lopez and Mireya Garcia conducted an announced case management inspection. The purpose of this inspection is to review staff files as they were not available for review at the Annual Required inspection conducted on 1/14/2020. LPA’s met with Director Linda Chuang, who guided analyst in the tour of the facility. There were no children or staff present during inspection.

Facility Records

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Staff Records were reviewed for completeness: Inspections of required forms was made. Upon LPA's review of staff #1 file items missing were Mandated Reporter Training AB1207, and Immunizations. LPA’s issued the Review of Staff Records (LIC 859) to the licensee during this inspection. The LIC 859 documents the staff’s files were reviewed during this inspection.

At this time, the facility is not incompliance with California Title 22 Regulations. Please see 809-D page 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 representative.

At 12:08 pm, exit interview was conducted with Director Linda Chuang, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

Report Ends here page 1 of 1.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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 2
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: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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1596.7995- Employees or volunteers at day care center; immunization requirements; records;exemptions. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
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The requirement is not met as evidenced by LPA's record review of Staff #1 was missing proof of immunizations.This poses a potential risk to the health and safety of children in care
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Per Director she will attend Step 2 Records Keeping and Operation Orientation on 3/19/2020 8:30am-1:00pm at Monterey Park Regional Offices 1000 Corporate Center Drive Monterey Park, CA 91754. Proof of certificate will be emailed to LPA Lopez upon completion.
Type B
03/06/2020
Section Cited

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1596.8662 Availability of info, regarding detecting and reporting child abuse and neglect;training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion (On or before 3/30/18,a person who,on 1/1/18, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every 2 years following the date on which he or she completed the initial mandated reporter training.
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This requirement is not met as evidenced by LPA's record review of Staff #1 was missing the required Mandated Reporter AB1207 certificate.This poses a potential risk to the health and safety of children in care.
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Proof of certificates for Staff 1 will be emailed to LPA Lopez by POC due date of 03/06/20.
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 GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2