198019558-6-4-2019-33-CC-CGRN-BCU24L-20190604170407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019558
Report Date: 06/04/2019
Date Signed: 06/04/2019 05:04:12 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 TREE ACADEMY HOLLYWOOD-INFANT		FACILITY NUMBER:	198019558
ADMINISTRATOR:	AMIR CASPIAN		FACILITY TYPE:	830
ADDRESS:	1519 N. KENMORE AVE		TELEPHONE:	(310) 314-1111
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90027
CAPACITY:	22	CENSUS: 17	DATE:	06/04/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:51 PM
MET WITH:	Stephanie Caspian		TIME COMPLETED:	05:15 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 Analyst (LPA) Crystal Green conducted an unannounced case management inspection regarding a request for a capacity increase. This facility is currently licensed for 22 infants and has submitted a request to increase to 52 infants. LPA met with Director, Stephanie Caspian, who guided analyst on a tour of the facility. Amir Caspian, Applicant, arrived later during this inspection. Census and staff name were recorded. LPA observed facility to be operating within its capacity limitation. This facility is located in the same cite as the Preschool Center #198019559. Facility hours of operation are Monday through Friday from 7:30 AM to 5:30 PM This is a three story building. Infant classrooms are located on the first floor. There are three classrooms that are used for the infant program. Classrooms are separated by 4 feet high walls. LPA observed the first floor to include a gated area to prevent infants from commingling with the preschoolers. There are three changing tables in the facility for infant program. Changing tables were placed in the infant bathroom, (0-12 months) classroom and (12-18 months) classroom. The Infant bathroom contains 1 toilet, 1 sink, 3 potty chairs, and 1 changing table. Infant changing tables have a padded surface no less than one inch thick and are covered with washable vinyl or plastic and have raised sides at least three inches high. Toys were observed to be clean and safe. The napping area is a separate room which has three doors to enter and will have a staff member inside during napping time. There are (17) cribs available, all of which are evacuation cribs, and (20) cots available for the older infants. Cubbies are available for children's belongings. Indoor capacity measurements were obtained during pre-licensing inspection conducted on 05/18/2018. Based on the measurements obtained indoor space allows for a capacity of (59) preschoolers. Outdoor space is limited to a capacity of twenty (20) infants.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE TREE ACADEMY HOLLYWOOD-INFANT	FACILITY NUMBER: 198019558
	VISIT DATE: 06/04/2019

NARRATIVE

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The outdoor activity area is surrounded by wooden fence to separate the preschool and infant programs. The outdoor play area has age appropriate play equipment and are in good condition. There is adequate shade in the play yard. Portable water will be provided to children during outdoor play.

This facility currently has an approved waiver on file which allows use of the outdoor play space on staggered schedule for the current capacity of 22. This facility has submitted an outdoor playground waiver based on the requested capacity increase. An approved Fire Clearance has been granted by the Los Angeles Fire Department for a capacity for a capacity of 52. At this time facility is in compliance with Title 22 and will be submitted for a capacity increase of 52 infants, pending approval from department for a waiver granting use of the outdoor play space on a staggered schedule.

LPA Green conducted an exit interview with Director, Stephanie Caspian. Appeal Rights were issued and discussed.

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

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

LIC809 (FAS) - (06/04)

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