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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370580
Report Date: 01/23/2023
Date Signed: 01/23/2023 02:55:06 PM

Document Has Been Signed on 01/23/2023 02:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:APPLE TREE LEARNING ACADEMYFACILITY NUMBER:
304370580
ADMINISTRATOR:SUK, JUNG H.FACILITY TYPE:
850
ADDRESS:2338 EAST WAGNER AVENUETELEPHONE:
(714) 284-0706
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 48TOTAL ENROLLED CHILDREN: 27CENSUS: 6DATE:
01/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:35 AM
MET WITH:Director Jung SukTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPAS), P. Rivas and A. Silva conducted an annual inspection. LPAs met with Director Jung Suk and commenced tour. Census was taken 7 children and two teachers were viewed. An assistant arrive during visit.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 6:30 am to 6:00 pm Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds) were observed to be stored within reach of children, but were removed during the inspection. The deficiency will be cited under LIC 809D. Poisons/Hazardous Items are not kept on the premises. Snacks and meals are prepared on site; Food prep areas were clean and sanitary. Food is properly stored. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by water pitcher and cups labeled with children's names. The children's bathrooms are clean and sanitary. The facility has conducted an emergency drill within the past six months on 1/17/23.. The facility has working carbon monoxide detectors and fire extinguisher that meet the State Fire Marshall Requirements. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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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Document Has Been Signed on 01/23/2023 02:55 PM - It Cannot Be Edited


Created By: Pat Rivas On 01/23/2023 at 12:58 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.4(d)
Storage Space
(d) Combustibles, cleaning equipment and cleaning agents shall be stored in an area separate from food supplies in a locked cabinet or in a location inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation , the licensee did not comply with the section cited above LPAs observed clorox and cleaning supplies were stored in kitchen pantry along with food . This poses a poential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2023
Plan of Correction
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Director removed items during visit and placed them underneath the sink in a locked cabinet.
Type B
Section Cited
CCR
101221(b)8(C)
Personnel Requirements
Child's Record
(C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 7 children's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Director will have parents complete and sign consent forms for all children in care. Liicensee will provide copy of consent forms for the 3 out of 7 children's files. Copy of forms to be sent to LPA by plan of correction date.
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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 01/23/2023 02:55 PM - It Cannot Be Edited


Created By: Pat Rivas On 01/23/2023 at 12:58 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in2 out of 7 children files. Which poses/posed ed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2023
Plan of Correction
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Director will obtain medical assessments for all children files and submit copies of two(previously reviewed) to LPA by plan of correction date.
Type B
Section Cited
CCR
101220(b)(2)
Child's Medical Assessments
(b) The medical assessment shall provide the following: (2) Results of a test for tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 7 children files. A tb risk assessment was also not provided. Which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2023
Plan of Correction
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licensee will ensure to obtain tb tests and results or tb risk assessment signed by a medical professional and submit to LPA by plan of correction date.
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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580
VISIT DATE: 01/23/2023
NARRATIVE
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3 Staff files were reviewed for staff present during the facility inspection on this date. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a Child Care Center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for the staff were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. All 3 staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 1/13/24.

7 Children's records were reviewed, and there was a separate and current record for each child. In the areas reviewed, Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.


This facility does not provides Incidental Medical Services (IMS). LPAs provided technical assistance for IMS and reminded licensee of PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child Care Homes 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

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning is wood chips and sand and grass around the climbing equipment, such as swings, slides and other similar equipment appeared to be enough to absorbs falls. There is a pool that has been completely filled (licensee states with dirt and rock). LPAs observed a slide, playground equipment, chairs on top of the filled pool. Drinking water in the outdoor activity space is provided by water pitcher and cups labeled with the children's names. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580
VISIT DATE: 01/23/2023
NARRATIVE
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The Director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The Director was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

In the areas that were evaluated, the following deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit (See LIC 809D).

An Inspection and exit interview was completed with Director Jung Suk. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 01/23/2023 02:55 PM - It Cannot Be Edited


Created By: Pat Rivas On 01/23/2023 at 01:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above i. LPAs observed can of llysol under the children's restroom sink which was accessible to children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2023
Plan of Correction
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licensee removed lysol can and made it inaccessible during visit, licensee will store where children can not reach
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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