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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411901
Report Date: 06/07/2023
Date Signed: 06/07/2023 03:16:59 PM

Document Has Been Signed on 06/07/2023 03:16 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAPLE PRIMARY CENTER STATE PRESCHOOLFACILITY NUMBER:
197411901
ADMINISTRATOR:SHARYN CLARKFACILITY TYPE:
850
ADDRESS:3601 S. MAPLE AVE. RM. 100 105TELEPHONE:
(323) 232-0984
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 40DATE:
06/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sharyn Clark, PrincipalTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection on 6/7/23. The purpose of this visit is to address two incidents that were reported to the department. Upon arrival, LPA met with Sharyn Clark, Principal. There were 40 children and seven staff present during inspection.

On 6/2/23, Principal submitted an unusual incident report to the Department regarding an incident that occurred that same day. Incident report stated that an alleged personal rights violation occurred between Staff One (S1) and Child One (1). Upon arrival Principal notified LPA that she was made aware on 6/6 of another alleged incident regarding a personal rights violation between Staff Two (S2) and Child Two (C2).

During inspection LPA obtained written report for the incident occurring on 6/6. LPA conducted interviews with children and staff and obtained other pertinent documentation. Due to insufficient information, further investigation is needed. LPA will conduct a follow-up visit.

LPA provided Principal with required posted documentation that was requested.

No deficiencies will be cited today 6/7/23.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days.

Exit interview was conducted with Principal, Sharyn Clark, during which appeal rights were explained.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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