197494263-1-31-2024-30-CC-JLAO-D223CV-20240131170834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494263
Report Date: 01/31/2024
Date Signed: 01/31/2024 05:08:47 PM

Document Has Been Signed on 01/31/2024 05:08 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 TREE ACADEMY WLA-INFANT		FACILITY NUMBER:	197494263
ADMINISTRATOR:	BLANCA SANCHEZ		FACILITY TYPE:	830
ADDRESS:	2920 S SEPULVEDA BL		TELEPHONE:	(323) 999-6930
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	70	CENSUS: 32	DATE:	01/31/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Amy Siciliano, Preschool Director		TIME COMPLETED:	12:00 PM

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On 1/31/2024 Licensing Program Analysts (LPA) Judy Laureano conducted an unannounced Annual Required Inspection for the infant license. LPA met with Amy Siciliano- Preschool Director and Karina Estrada- Infant Assistant Director and toured and inspected the facility indoors and outdoors. Infant director Blanca Sanchez was not present during today’s inspection. Facility is a combo center with a preschool license on the same site; preschool license 197494264.

LPA observed the following:
Sugar Maples 1- 9 children and 3 staff members
Sugar Maples 2- 12 children and 3 staff members
Sugar Maples 3- 12 children and 3 staff members

Facility operates Monday through Friday 7:30 a.m. to 5:30 p.m. Facility prefers to service children 0 to 2 years of age. Waiver and outdoor playground schedule on file and posted on the parent board. Outdoor waiver grants not more than 35 infants to use the outdoor space at any given time.

The facility has sufficient age appropriate furniture, and equipment including cribs, cots or mats, changing tables and feeding chairs. There is indoor and outdoor activity space for infants that is physically separate.

Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Director confirmed that a teacher is always supervising sleeping infants and completes the infant safe sleep log. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping. LPA emailed facility admin Safe Sleep resources.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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 ACADEMY WLA-INFANT	FACILITY NUMBER: 197494263
	VISIT DATE: 01/31/2024

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There are no baby walkers on the premises. Changing tables have at least a 1-inch-thick padding covered with washable vinyl or plastic. Sides are raised to a minimum of 3 inches. Changing table is within an arm's reach of a sink. There is a minimum of 1 potty chair or toilet for every 5 infants currently toilet training. LPA observed diapering log and facility admin confirm that parents receive log information via Procare (online application).

Sanitary solution (bleach solution) is out of reach to infants in care. Disinfectants and cleaning solutions are kept in a locked laundry room, making the content inaccessible to the children in care. Classrooms were observed and inspected. Younger infants sleep in a separate room while older infants sleep on cots.

All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. Facility does not provide or prepare any meals for infants, families are required to bring all food, formula and snacks. All food is protected against contamination and any contaminated food is discarded immediately. Allergies and dietary restrictions are posted in the kitchen area. Director confirmed that children over the age of 2 years old, snacks are provided by facility

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. LPA observed working fire extinguishers throughout the facility. A centralized fire alarm, smoke detectors and carbon monoxide detectors throughout the classrooms. All electrical outlets were observed to be covered. Facility admin confirmed that fire equipment is tested once a year.

Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Children are encourage to bring their refillable water bottles and/or sippy cups. LPA observed a water dispenser in each classroom.

Facility is open to take children who might need medication, currently facility does not have a child enrolled in the infant program that requires medication. Medication will be stored in the child’s perspective classroom. Prescription medications shall be administered in accordance with the label directions as prescribed by the child’s physician. Medication should be in its original content with all necessary LIC forms completed.

Fire drills and earthquakes drill log was reviewed. First Aid Kit bags were observed in the classroom. LPA observed emergency kit outside the infant classrooms and reminded facility director to have a system in place where items are check annually.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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 ACADEMY WLA-INFANT	FACILITY NUMBER: 197494263
	VISIT DATE: 01/31/2024

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Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA observed age appropriate play equipment and toys.

All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

The facility is free of flies, insects and rodents, pest control services comes monthly, There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Facility was observed with a centralized sprinkler system and fire alarm.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. 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.

Capacity and limitations as specified on the license are being maintained.

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. Facility uses an online system sign in/out sheet, Procare. LPA observed QR Code instructing parents to sign in/out and a hard copy was available for LPA’s review.

All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care.

LPA reviewed a sample of children’s files and observed 6 files were complete. All files were observed to be complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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 ACADEMY WLA-INFANT	FACILITY NUMBER: 197494263
	VISIT DATE: 01/31/2024

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At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. LPA reminded facility to ensure all Infant/Adult and Child CPR and First Aid is EMSA Approved. Any adult who provides care and supervision and/or volunteers need to have proof immunization for influenza, pertussis, and measles. Staff records contain documentation of meeting qualification requirements. LPA reviewed 9 staff files and files were complete. LPA emailed a copy of the LIC311A and LIC 125 to use as a reference when auditing program and program files.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for

drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC809 (FAS) - (06/04)

Page: 6 of 7

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 ACADEMY WLA-INFANT	FACILITY NUMBER: 197494263
	VISIT DATE: 01/31/2024

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Amy Siciliano

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC809 (FAS) - (06/04)

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