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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700610
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:47:01 PM

Document Has Been Signed on 02/17/2023 01:47 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
075700610
ADMINISTRATOR:DILLARD, DAWNFACILITY TYPE:
850
ADDRESS:17025 BOLLINGER CANYON ROADTELEPHONE:
(925) 560-6488
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 165TOTAL ENROLLED CHILDREN: 165CENSUS: 72DATE:
02/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Teresa AddisonTIME COMPLETED:
02:05 PM
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A Prelicensing inspection was conducted today 02/17/2023 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Applicant, Teresa Addison and Director, Dawn Dillard. The applicant has submitted a CHANGE IN OWNERSHIP application for a PRESCHOOL license for 165 preschoolers. The program will operate from 7:00AM - 6PM, Monday through Friday, in 8 classrooms. Present during today's visit were 10 additional staff members and 72 preschool aged children. A health and safety inspection was conducted inside and outside. Measurements were taken by a previous LPA and per Licensee, no changes have been made. Measurements are as follows:

INDOORS: 5993.48 square feet = 171 children
OUTDOORS: 12930.48 square feet = 172 children

The center has obtained an approved fire inspection clearance from the San Ramon Valley Fire Department on 1/30/2023.

The facility consists of one building with a total of 8 classrooms. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 11 toilets and 11 sinks available for children use. Staff toilet is located on the premises. Facility will provide AM/PM snacks and children will bring lunch from home. Menu will be posted at least one week in advance in a place visible for the authorized representative to see. Facility will have the Director's office and staff bathroom serve as isolation areas for ill children. Cots and mats were observed today.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 075700610
VISIT DATE: 02/17/2023
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This facility plans to provide Incidental Medical Services - IMS. 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

The play yards are fenced in all around. Building overhang, tarps and trees provide sufficient shade in the play yard. Children will bring their water bottles from home and the facility will refill as necessary. Water fountain on the play yard could be used while children are outside. No cleaning agents were found stored with food. There is a refrigerator available. First aid supplies are available in the center. There is a working telephone on site. Facility will utilize an electronic sign in/out software that has a separate PIN/login for each authorized representative. Paper sign in/out sheets will be utilized should the electronic software be unavailable.

Dawn Dillard is a fully qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid. Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 applicant 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.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 075700610
VISIT DATE: 02/17/2023
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A license for 165 preschool children will be issued effective today 2/17/2023.



Exit interview conducted with Applicant, Teresa Addison.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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