198008421-6-9-2023-33-CC-VMGA-CSMRMX-20230609130928

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198008421
Report Date: 06/09/2023
Date Signed: 06/09/2023 01:09:36 PM

Document Has Been Signed on 06/09/2023 01:09 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MAPLE AVE. AFTER SCHOOL EDUCATION CENTER		FACILITY NUMBER:	198008421
ADMINISTRATOR:	CHUANG, LINDA		FACILITY TYPE:	840
ADDRESS:	320 N. MAPLE AVE.		TELEPHONE:	(323) 724-3939
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 25	CENSUS: 0	DATE:	06/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Owner Linda Chuang and Director Irene Lopez		TIME COMPLETED:	01:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced 1-year required inspection at the above facility on 06/09/23 at 11:35 a.m. A COVID-19 risk assessment was conducted prior to entering the facility inspection at this facility. LPA met with Irene Lopez, Director and Owner Linda Chuang who guided analyst on tour of the facility. This is an after-school program offered to school-age children. Hours of operation are from 7:00 a.m. - 05:30 p.m. Per Director, children are in the facility from 7:00 am- 8:00 a.m. and from 2:45 p.m. - 05:30 p.m. Per Owner, there are 15 children enrolled. There were 0 children present during this inspection. This is a two-story facility which consists of (2) classrooms, (2) children's restrooms and a fenced backyard. The off limit areas for children include the upstairs room, which is licensed but it is not used due to low enrollment. LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, Snack Menus, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed, last drill was conducted on 05/18/23. LPA observed activity scheduled posted. LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are safe, in sanitary conditions. LPA observed the back toilet has a broken handle. LPA flushed the toilet using the broken handle and observed it to be operational. LPA observed school age restrooms to be individual toilets and sinks as required. All classroom floors were observed to be safe and clean. Page 1 of 3

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE AVE. AFTER SCHOOL EDUCATION CENTER	FACILITY NUMBER: 198008421
	VISIT DATE: 06/09/2023

NARRATIVE

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The second floor is used as an isolation area. Parents are contacted immediately when children are determined to be ill, and staff are ensuring that children with obvious symptoms of illness are not being accepted. Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides PM snack. LPA observed jugs of water and disposable cups available for drinking water. All containers used for storage of solid wastes have a tight-fitting cover on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility does not have Poisons. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

LPA observed the outdoor playground is fully fenced. Outdoor play equipment was observed to be in good condition, free of sharp, lose or pointed parts. LPA observed age-appropriate toys and equipment. The areas around and under high climbing equipment, slings or slides have a rubber cushioning that absorb a fall. Outdoor activity space surface is maintained in a safe condition as is free of hazards.

Owner states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this inspection.

Owner states there are no weapons or firearms on the premises. Transportation services are not provided at this facility.

Staff Records were reviewed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights. LPA observed staff records to be complete.

Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 995 Notification of Parent’s Rights, and LIC 627 Consent for Emergency Medical Treatment. LPA observed children's files were observed to be complete.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE AVE. AFTER SCHOOL EDUCATION CENTER	FACILITY NUMBER: 198008421
	VISIT DATE: 06/09/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. Per Owner, there are no children on medications. 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.

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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview conducted and report was reviewed with Director Irene Lopez and appeal rights were provided.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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