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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203097
Report Date: 11/15/2022
Date Signed: 11/15/2022 12:21:30 PM


Document Has Been Signed on 11/15/2022 12:21 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, 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: 13DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Carly Velasquez and See YangTIME COMPLETED:
12:35 PM
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On November 15th, 2022 at 10:10AM Licensing Program Analyst (LPA) Rosie Breault conducted a Required Annual / Random inspection. LPA met with Site Supervisor Carly Velasquez and explained the purpose of the inspection. LPA asked Covid-19 screening questions and no exposure on site. Site Supervisor informed LPA that she needed to leave facility; however, gave full authority to Teacher See Yang to assist with inspection, and review/sign the report. Teacher along with LPA, conducted a tour of the facility inside and out. There were thirteen (13) children in care at the time of the inspection and four (4) staff. The center operates from 7:00AM-5:30PM and is open Monday thru Friday.

Licensing required notices were posted prominently at the front entrance. Facility uses a written sign in / out sheet. Facility provides breakfast, lunch, and afternoon snack with menu posted prominently. Kitchen was observed to be clean, functioning, and free of pests. The facility currently uses one (1) classroom and one (1) bathroom. Bathrooms were outfitted with ample sinks, toilets, hand washing supplies, are functioning, and free of toxins. Facility provides filter water with children using disposable cups. Children have access to water, along with hand washing stations both inside and outside. LPA noted age appropriate toy and furnishings in classrooms. The facility provides cots for napping and individual bedding is kept separate from one another. Cleaning supplies, compounds, combustibles, sharps, and hazards were observed to be inaccessible to children. First aid kits are available both in classroom and outside, labeled, and inaccessible to children. LPA observed play yard to contain age appropriate toys/equipment with perimeter fencing and ample shade to access. There are no bodies of water present.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAC - MAPLE CENTER
FACILITY NUMBER: 426203097
VISIT DATE: 11/15/2022
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The last fire dire was conducted on October 24th, 2022. Facility provides Incidental Medical Services. Medication was properly labeled, dated to current, paperwork present, locked, and stored inaccessible to children.

Staff and children records were available upon request. A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. LPA observed staff files to be complete. Teacher present has a current Pediatric CPR/First-Aid certificates that is valid until 04/30/2024.

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

There were no deficiencies cited during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Teacher Yang.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC809 (FAS) - (06/04)
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