198014836-4-4-2023-33-CC-MGAA-CQKTND-20230404145234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014836
Report Date: 04/04/2023
Date Signed: 04/04/2023 02:53:54 PM

Document Has Been Signed on 04/04/2023 02:53 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MAPLE AVENUE PRESCHOOL		FACILITY NUMBER:	198014836
ADMINISTRATOR:	JENNIFER CHUANG		FACILITY TYPE:	850
ADDRESS:	324 - 324 1/2 N. MAPLE AVE.		TELEPHONE:	(323) 724-3939
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY: 55	TOTAL ENROLLED CHILDREN: 10	CENSUS: 9	DATE:	04/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Director, Irene Lopez & Owner, Linda Chuang.		TIME COMPLETED:	02:25 PM

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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Annual Required Inspection. LPA met with Director, Irene Lopez who guided LPA on a tour of the facility indoors and outdoors. Owner, Linda Chuang later arrived during this inspection. This is a preschool program which consists of 2 buildings; building with address 324 consist of one classroom; Room #1 and building with address 324 ½ consist of one classroom Room #2. Per Director Room #2 is currently not in use due to low enrollment. Facility operation hours are Monday through Friday from 7:00 AM to 5:30 PM. This facility has a capacity of 55 children; ages (2) until entry into first grade.

Upon arrival, the following staff were present during this inspection: Room #1: Staff #1 and Staff #2 with 9 preschoolers, Room #2 was observed not in use. Teacher-child ratio is met. All individuals present have obtained a criminal record clearance or criminal record exemption. All children were observed to be under visual supervision of a teacher at all times.

REPORT CONTINUES ON NEXT PAGE 1 OF 5.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE AVENUE PRESCHOOL	FACILITY NUMBER: 198014836
	VISIT DATE: 04/04/2023

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LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Indoor classroom was inspected to ensure that the floor has a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the Room #2 is used as an isolation area. There are chairs and a mat inside the room. 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. Preschoolers are provided with Lunch and AM & PM Snack. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. There is drinking water available in all indoor classrooms per director children bring their own water bottles from home and water bottles are available if needed. Children's personal water bottles are taken outdoors during outside play. All storage containers for solid waste, including moveable bins, have tight fitting covers 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. Director states that there are no poisons stored at the facility.
REPORT CONTINUES ON NEXT PAGE 2 OF 5.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE AVENUE PRESCHOOL	FACILITY NUMBER: 198014836
	VISIT DATE: 04/04/2023

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The valve on the required 2A 10BC fire extinguisher indicates fully charged with a service tag dated 02/06/2023. The smoke and carbon monoxide detectors located inside the Room #1, were tested at 10:46 a.m., and are in operable condition.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Areas around and/or under climbing equipment and slides have soft cushioning to absorb a fall. At 9:56 a.m.,LPA Garcia observed the cushioning near the slide area has a tear square piece the size of 12 inches by 12 inches (Pictures were taken).

Sign in and out sheets were reviewed by LPA to ensure that children who are present where sign in. Staff Records were reviewed to ensure that personnel records are maintained on all staff. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. LPA issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Director during this inspection. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

REPORT CONTINUES ON NEXT PAGE 3 OF 5.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE AVENUE PRESCHOOL	FACILITY NUMBER: 198014836
	VISIT DATE: 04/04/2023

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AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

Incidental Medical Services (IMS) policy was discussed. Per Director there are currently no children enrolled who required IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

The following was discussed:

Reporting Requirements.
The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.
All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

REPORT CONTINUES ON NEXT PAGE 4 OF 5.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAPLE AVENUE PRESCHOOL	FACILITY NUMBER: 198014836
	VISIT DATE: 04/04/2023

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LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

During the inspection LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility representative during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Per facility representative at this time the facility has not tested water outlets. LPA discuss and provided a copy of the PIN 21-21.1-CCP: WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS PURSUANT TO AB 2370 CHAPTER 676, STATUTES OF 2018.

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited.

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

Exit interview conducted and report was reviewed with facility representative, Irene Lopez.

REPORT ENDS HERE PAGE 5 OF 5.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 04/04/2023 02:53 PM - It Cannot Be Edited

Created By: Mireya Garcia On 04/04/2023 at 01:22 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MAPLE AVENUE PRESCHOOL	FACILITY NUMBER: 198014836
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation at 9:56 a.m.,during outdoor inspection LPA observed the cushioning near the slide area of the climbing structure has a tear square piece the size of 12 inches by 12 inches (Pictures were taken). This poses a potential health and safety risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Per Director a service request will be placed to have the tear of the matting patched and pictures of the correction will be sent to LPA Garcia via email by POC due date 04/28/2023.

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review and interview discloure with Director who states the facility has not test their drinking water for lead. This poses a potential health and safety risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Per Director, facility will contact vendors and will have water outlets tested and will follow written directives indicated in PIN 21-21.1-CCP and will notify LPA Garcia via email upon completion by POC due date 04/28/2023.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Brandi VanOosten

LICENSING EVALUATOR NAME:

Mireya Garcia

LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

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