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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401085
Report Date: 05/16/2024
Date Signed: 05/16/2024 04:16:36 PM

Document Has Been Signed on 05/16/2024 04:16 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LA PETITE ACADEMY INC.FACILITY NUMBER:
197401085
ADMINISTRATOR/
DIRECTOR:		WARD, AIMEEFACILITY TYPE:
850
ADDRESS:43741 CHALLENGER WAYTELEPHONE:
(661) 945-1800
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 12DATE:
05/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Aimee WardTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 05/16/2024, at 1:45 P.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at La Petite Academy Inc. LPA met with Director Aimee Ward and was allowed access to the facility. LPA stated purpose of the inspection was to follow-up on a self-reported Unusual Incident Report (UIR) that happened on 05/09/2024 at the center. The investigation included an inspection of the facility where the incident occurred, facility records, and confidential with staff members. LPA was provided with copies of the Child Care Roster and the Face-to-Name Transition Sheet dated 05/09/2024.

During this visit, LPA observed 12 preschool children with 1 staff providing care and supervision.

Based on records review, the staff are fully qualified teachers. However, one of two staff has expired mandated reporter training dated 05/05/2022. The director was advised to send a copy of the training certificate no later than Friday, 05/16/2024.

Based on the information gathered, the incident happened on 05/09/2024 at 11:25 A.M. when the children were transitioning from the playground to the two’s classroom. A total of 10 children and 2 staff were present when the incident occurred. Child #1 was left unsupervised in the outside playground for 18 minutes. Staff #2 notified the front office, and the child was retrieved from the playground at 11:43 A.M.

During the interview with the staff, staff 2 admitted that she did not follow the protocol of checking the children when they are inside the classroom, thereby, miscounted the child that is missing. Although the facility reported the teacher followed procedures when entering the classroom from the playground and when notifying the front office, the care and supervision violation did occur.

A Type A deficiency is cited based on interviews and record review, and per California Code of Regulations, Title 22, Division 12. see LIC 809D.

Upon receipt of a Type A deficiency, the licensee shall post the report for 30 days in addition to the Notice of

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 197401085
VISIT DATE: 05/16/2024
NARRATIVE
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Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

A LIC 9213 Notice of Site Visit was left at facility and must be posted for 30 days. Failure to do so will result in an immediate civil penalty assessment of $100.00.



An exit interview was conducted, where the plan of correction was reviewed and developed with Director Aimee Ward. A copy of this report and appeal rights were discussed with the Director Aimee Ward.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/16/2024 04:16 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 05/16/2024 at 03:57 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 197401085

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision. Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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The director will retrain the teacher and staff on the face-to-name procedure and provide LPA with a copy of the training regime and a sign-in sheet of the staff that attended the training course.
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Based on interviews and records, it was determined that C1 was left unsupervised in the outside playground of the facility for approximately 18 minutes. This poses a potential risk to the health, safety, or personal rights of the children in care.
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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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
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