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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492822
Report Date: 09/01/2022
Date Signed: 09/01/2022 01:13:51 PM

Document Has Been Signed on 09/01/2022 01:13 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MAPLE TREEFACILITY NUMBER:
197492822
ADMINISTRATOR:TINA COLOMBELFACILITY TYPE:
850
ADDRESS:1814 14TH STREETTELEPHONE:
(310) 314-1111
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 33DATE:
09/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tina ColombelTIME COMPLETED:
01:30 PM
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On 9/1/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director, Tina Colombel, and toured the indoor and outdoor of the facility. Days and hours of operation are Monday through Friday, 7:30am to 5:30pm.

The preschool is located on the second floor and can be accessed via an elevator or stairs. Seven rooms are currently in use and can be accessed via a main hallway. Room 202 is dedicated to 2 to 2 1/2 year olds. LPA observed 1 changing table, rug for circle time, and age-appropriate books and learning materials. Room 206 is dedicated to 2 1/2 to 3 year olds. In this room, LPA observed mats laid off for napping. Room 210 is dedicated to 4 to 5 year olds, and LPA observed age-appropriate tables, toys, and books. Room 201 is the music and movement room, and LPA observed mats, 1 teepee, and age-appropriate learning materials. Room 212 is the art studio, and LPA observed tables and materials for arts and crafts. The kitchen and dining area is located in rooms 204 and 205. On the left side, LPA observed children's tables and chairs as well as refrigerator with allergies posted. On the right side, LPA observed a kitchen prep area that is clean and organized. Children bring their own food and facility provides a morning and afternoon snack. The children's bathroom is also included in this room. LPA observed 6 toilets, 6 sinks, and 1 changing table. In the hallway, LPA observed a garden area and two children's tables where children can also eat meals and snacks. LPA observed a functioning 2A10:BC fire extinguisher in the hallway and fire sprinklers in all classrooms. Room 200 is the director's office, which serves as the isolation room. The staff lounge is located on third floor room that has a bathroom, and a kitchenette. The staff bathroom on the third floor or the second one located on the first floor will be used by sick children.



The facility uses a modified indoor space for outdoor activities located on the first floor, and was granted a capacity of less than the requested capacity due to the limited outdoor space. This area is divided into 3 sections: 1) area for riding children's bikes, 2) area matted flooring, 1 climbing structure, 1 couch, 1 changing
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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MAPLE TREE
FACILITY NUMBER: 197492822
VISIT DATE: 09/01/2022
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table, 1 sink, 3) sandbox and obstacle course area. The facility was granted an outdoor activity space waiver at the time of licensure, allowing the outdoor activity space to be used on a staggered play schedule. The outdoor area enclosed by a gate, and is divided into two sections: 1) water play and 2) picnic tables area.

Director 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. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Facility maintains a ratio of one teacher supervising no more than 12 children in care. All staff are trained in CPR and Pediatric First Aid. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day.

LPA reviewed a sample of 10 children’s files and observed files were complete. LPA reviewed a sample of staff files and observed files were complete.

Incidental Medical Services (IMS) are currently being provided. Director is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. Exit interview conducted and report was reviewed with the Director, Tina Colombel.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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