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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203097
Report Date: 10/21/2019
Date Signed: 10/21/2019 11:20:38 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAC - MAPLE CENTERFACILITY NUMBER:
426203097
ADMINISTRATOR:ANGELA MCQUITERFACILITY TYPE:
850
ADDRESS:120 W. MAPLETELEPHONE:
(805) 736-7574
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:40CENSUS: 18DATE:
10/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Carly VelasquezTIME COMPLETED:
11:30 AM
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An annual review was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and B. Cervantes who met with Site Supervisor Carly Velasquez. The center was toured inside and outside. The Site Supervisor stated there are no firearms/ammunition or bodies of water on the premises. LPAs did not observe any bodies of water. The preschool operates a full day session Monday – Friday, 7:15 AM - 5:30 PM and two part day sessions Tuesday - Friday two sessions 7:55 AM - 11:30 AM and Tuesday and Thursday 1:00 PM - 4:30 PM. LPA reviewed the medication for child #1 which is maintained in a locked box inaccessible. The classrooms were observed to be clean and orderly. The appropriate documents including the menu was posted for review. LPAs reviewed the handouts “A Child Care Provider’s Guide to Safe Sleep, Safe Sleep in Child Care, Effects of Lead Exposure". There is a dual smoke/carbon monoxide detector in the center. The restrooms were observed to clean. The outside playground equipment was observed to be well maintained and age appropriate. A random review was conducted of children's records. Staff records were reviewed. LPAs reviewed current CPR and First Aid for three staff. LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. Verification was reviewed for staff. Also reviewed was certificate of completion of AB1207 Child Abuse Mandated Reporter Training.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAC - MAPLE CENTER
FACILITY NUMBER: 426203097
VISIT DATE: 10/21/2019
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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 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

No deficiencies cited. The Notice of Site Visit was posted at the visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
LIC809 (FAS) - (06/04)
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