<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419097
Report Date: 01/22/2025
Date Signed: 01/22/2025 12:36:42 PM

Document Has Been Signed on 01/22/2025 12:36 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PETITE SCHOOL HOUSEFACILITY NUMBER:
197419097
ADMINISTRATOR/
DIRECTOR:		SALMEENA ZAKIFACILITY TYPE:
850
ADDRESS:17643 ROSCOE BLVD.TELEPHONE:
(818) 708-8766
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 182TOTAL ENROLLED CHILDREN: 182CENSUS: 96DATE:
01/22/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Director Salmeena Zaki TIME VISIT/
INSPECTION COMPLETED:
12:50 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) Roberto Luque Avila conducted an unannounced case management health and safety visit to the above facility on 1/22/2025. LPA arrived at the facility at 10:45AM, identified self and met with Director Salmeena Zaki who guided analyst on a tour of the facility. LPA observed 96 children 13 staff upon arrival. Per director, operation hours are 6:30AM to 6PM.

LPA observed that Staff 1 (S1) who is present Monday through Friday from approximately 8:15AM to 5:15PM is not currently associated to the facility. Director was unable to find S1 in their guardian associations at this time. The director stated that S1 was disassociated from the facility and later returned to work with the facility and was not associated upon retuning to work in Petite School House in 3/16/2022. LPA contacted office support staff who confirmed that S1 was separated from Petite School House on 11/15/2021 and was not re-associated to the facility. During todays visit, the Director was able to associate S1 to the facility and will wait for S1 to be associated prior to returning to work.

Facility was cited type A deficiencies and an immediate civil penalty of $500.00
See LIC809D

Director was advised upon receive of this report, the report must be posted along with the notice of site visit for 30 days for parents to view. Director must inform the parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months via form LIC 9224 Acknowledgement of Receipt of Licensing Reports. If the Licensee fails to comply $100.00 civil penalty shall be assessed for each family enrolled and in attendance.

Exit interview was conducted and a copy of this report and notice of site visit was provided to Director, Salmeena Zaki.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/22/2025 12:36 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 01/22/2025 at 11:42 AM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
01/22/2025
Section Cited
CCR
101170(e)(2)

1
2
3
4
5
6
7
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
(2)Request a transfer of a criminal record clearance.
1
2
3
4
5
6
7
The director sent S1 home and associated them to their facility. They will return to the facility once their background clearance is transfered.

POC corrected at time of visit.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
S1 was not currently associated to the facility due to transfer of criminal record clearance not have been done.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Rita Ramos
LICENSING EVALUATOR NAME:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2