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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495059
Report Date: 09/19/2022
Date Signed: 10/26/2022 11:52:35 AM

Document Has Been Signed on 10/26/2022 11:52 AM - 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 VENICEFACILITY NUMBER:
197495059
ADMINISTRATOR:BLANCA SANCHEZFACILITY TYPE:
830
ADDRESS:11827 VENICE BLVDTELEPHONE:
(310) 314-1111
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 0DATE:
09/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Amir Caspian - OwnerTIME COMPLETED:
02:08 PM
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ON 10/26/2022 -THIS IS AN AMENDED REPORT OF THE RECORDED ON 9/19/2022, CORRECTIONS WERE MADE TO VERBAGE ON PAGE 1 AND ***On 9/19/2022 at 9:44 A.M. Licensing Program Analyst (LPA) Jillinda Chandler made an announced visit to Maple Tree Academy Venice for the purpose of conducting a pre-licensing inspection. The applicant is requesting an Infant component with a capacity of 80 children, ages 0 - 2 years (197495059), the facility also has a pending preschool application (197459560). The two programs are in the same building, the building is a two-story building. Two rooms on the lower level and 4 rooms upstairs rooms upstairs will be dedicated to pre-school activity.
Infant care will be provided on the lower level. The center's fire clearance allows for children 2-year-old and older to have class on the upper level. There is an approved fire clearance conducted by Inspector Sivaborvorn of the L.A Fire Department Bureau of Fire Prevention. LPA met with Amir Caspian and a tour of the facility was conducted.
The following was observed of the:
INDOOR ACTIVITY SPACE

Fire extinguishers were 2AB10C or larger.

The school has a fully integrated fire alarm system with smoke and carbon detection

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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 ACADEMY VENICE
FACILITY NUMBER: 197495059
VISIT DATE: 09/19/2022
NARRATIVE
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Parents and authorized adults will sign in using an electronic devise

The required postings were also posted in a prominent area for parents and visitors view.

The crib area was located in a separate room with 15 standard cribs (with no drop down sides) all of the cribs were equipped with wheels for emergency evacuation. Cribs had tight fitting mattresses. LPA observed adequate spacing between cribs

LPA observed low age appropriate tables and chairs.

Changing tables were observed within arms reach of a sink

Individual cubbies for infants diapering needs and belongings were observed


No baby walkers or bouncers were observed during today inspection.


The facility has cameras in classrooms and outdoor activity areas.
The measurements for the indoor activity space was 2670.28 divided by 35 SQ. FT. per child = 76 children

The food/activity area was calculated indoor capacity space





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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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 VENICE
FACILITY NUMBER: 197495059
VISIT DATE: 09/19/2022
NARRATIVE
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FOOD SERVICE:

Lunches and snacks will be provided by, parents are to prepare bottles, the center will heat them according to service plan, It is recommended that bottle fed infants are fed at least every four hours.

The center is hereby advised that a supply formula shall to be available for emergency purposes, emergency formula can be provided by parents or childcare center. refrigeration was observed for storing food and formulas

Infant bottles and foods shall be properly labeled with child’s names and date of preparation. The kitchen was clean in good condition, LPA did not observe any contaminated foods or hazardous conditions in this area.

sample menus were posted for review. Applicant shall make preparation for alternate meals for children with allergies. The plan must be in accordance with an Incidental Medical Service plan, and discussed with parents of children with, allergies (epi-pen); asthmatic (inhalers); and children needing Gastronomy tubes (feeding G-tube).

Applicant is hereby informed that regulations referencing infant care can be located in Title 22 Division 12 Chapter 1 Subchapter 02. Infant Care Center

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC809 (FAS) - (06/04)
Page: 4 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 VENICE
FACILITY NUMBER: 197495059
VISIT DATE: 09/19/2022
NARRATIVE
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age appropriate toys and equipment were observed in good repair.

Central heating and cooling was used to control the class room temperature.

Adequate lighting was observed

The classrooms were clean, rugs were in good condition

Trash cans used for solid waste were observed with tight fitting petal operated lids

Disinfectants and cleaning solution and other toxins or poisons were made inaccessible to children, placed a storage room.

The directors office will be used for isolation of ill children and the staff restroom. LPA observed a pack and play for infants that are requiring to be in a crib.

Applicant is hereby advised to add form # LIC 9227- Infant Sleeping Plan to the infants file folder. All service plans shall be adjusted according to child's needs.

The classrooms are not equipped with working telephones the nearest working telephone is at the front desk

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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 VENICE
FACILITY NUMBER: 197495059
VISIT DATE: 09/19/2022
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RESTROOMS

THERE WERE:

3 toilets = 1 toilet per 15 children for a total of 45 children, Licensee will provide 1 potty chair for every 5 children being potty trained.

8 sinks = 1 sink per 15 children for a total of 120 children. There were a total of 3 changing tables with sinks attached and 2 separate sinks in addition to the 3 sinks in the restroom.

Toilets and sinks were age appropriate

The restrooms were clean and sanitized with the necessary toiletries, sinks and toilets were operable and in good repair. Faucets delivered cold water.

OUTDOOR ACTIVITY SPACE

Age appropriate toys and equipment were observed in good condition.

The play yard gated with a 4 feet or higher gate.

No hazardous conditions or equipment was observed during today’s visit.

Sand was observed for cushioning under the climbing apparatus, and artificial grass in other areas of the outdoor activity area. page 5

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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 VENICE
FACILITY NUMBER: 197495059
VISIT DATE: 09/19/2022
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Artificial grass was observed for cushioning

No hazardous conditions or equipment was observed during today’s visit.

Measurements for the outdoor activity space = 1444.73 divided by 75 SQ. FT per child for a total of 19 children

Center is requesting a waiver for Title 22, section 101238.2 Outdoor Activity Space that states in part: (a) There shall be at least 75 square feet per child of outdoor activity space based on the total licensed capacity.

Based on measurements and observations the center shall be recommended for licensure pending approval of the requested waiver, for a capacity of 76 determined by the facility indoor capacity.

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.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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 VENICE
FACILITY NUMBER: 197495059
VISIT DATE: 09/19/2022
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Applicant 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.

LPA discussed the safe sleep regulations with applicant 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 [facility representative] 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.

Exit interview conducted and report was reviewed with the applicant Amir Caspian

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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