198019558-6-17-2021-33-CC-RLOZ-C43UEU-20210617153145

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019558
Report Date: 06/17/2021
Date Signed: 06/17/2021 03:31:54 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:	52	CENSUS: 15	DATE:	06/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Director, Isabel Rojas & Licensee, Amir Caspian		TIME COMPLETED:	03:45 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 (LPA’s) Roxana Lopez and Mireya Garcia conducted an unannounced required inspection. LPA’s met with Director, Isabel Rojas, who guided LPA’s on a tour of the facility. Licensee Amir Caspian joined the inspection and continued touring the facility with LPA’s. This is an infant program licensed for 52 children. This facility operates Monday – Friday from 7:30 AM – 5:30 PM. Per the Director there are 22 children enrolled. This is a combination center with preschool license on site, License # 198019559. All areas identified on the facility sketch were inspected. Upon arrival, LPA observed 8 children with 2 staff in room Sugar Maples # 3 and 7 children with 2 staff in sugar Maples # 1. Teacher-infant ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. Classrooms were observed to ensure that infants are never left unattended and under the direct visual supervision of a staff person at all times. The facility was inspected to ensure that it is clean, safe, sanitary, and in good repair to ensure the safety and well being of children, employees and staff. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. The facility has age appropriate furniture and equipment including but not limited to cribs, cots/mats and changing tables. LPA observed that infant changing tables are within an arm’s reach of a sink. LPA observed sufficient infant napping equipment that meets the requirements of Title 22 regulations. LPA did not observe any baby walkers or any items that fall into that category present in the facility. Storage for medication was inspected to ensure that medications are in a safe place inaccessible to children. At this time, the office is used as an isolation area. There are chairs in the office. Parents are contacted immediately when children are determined to be ill. ------------------------------------------------------ Pg.1 of 3 ------------------------------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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: 06/17/2021

NARRATIVE

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The facility does not provide any meals for infants all food is provided by parents. LPA observed that bottles, dishes, and containers of food brought by the infant’s authorized representatives are labeled with the infant’s name and current date. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to infants. The facility has an Intelliknight (Models 58Z0XL-EVS) system for fire and emergency responses installed. Per city of Los Angeles fire code requirements for E occupancy. Which are for schools and child care centers. The display currently reads “All systems normal” A test was conducted and the system showed no faults.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit.

Sign in and out sheets were reviewed to ensure that children present are signed in. Staff Records were reviewed to ensure that personnel records are maintained on all staff. Also to ensure that Teacher’s present have required infant units on file and are qualified. Children’s Records were reviewed to ensure that each child has a separate, complete, and current record, a Needs and Services Plan, and a medical assessment are on file. LPA’s observed the LIC 9227 Individual Infant Sleeping Plan in files. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.

SB792 Immunization Requirements for Staff and Employees was discussed with the Licensee and Director. All staff have immunization documentation.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee and Director. Website provided: http://mandatedreporterca.com/

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and ------------------------------------------------------ Pg. 2 of 3 --------------------------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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 TREE ACADEMY HOLLYWOOD-INFANT	FACILITY NUMBER: 198019558
	VISIT DATE: 06/17/2021

NARRATIVE

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101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA provided the following documents about Safe sleep: Pin 19-02-CCP Safe Sleep Awareness Campaign and Pin 20-24-CCP Recently Approved Safe Sleep Regulations in Effect.

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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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.

Exit interview was conducted with Director, Isabel Rojas Appeal Rights and Procedures explained and provided.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

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