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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000853
Report Date: 06/21/2023
Date Signed: 06/21/2023 11:15:52 AM

Document Has Been Signed on 06/21/2023 11:15 AM - 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:LA PETITE ACADEMY INC.-GRAND AVE.FACILITY NUMBER:
198000853
ADMINISTRATOR:KAMAL GUPTAFACILITY TYPE:
850
ADDRESS:722 SO. GRAND AVE.TELEPHONE:
(909) 860-4009
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 118TOTAL ENROLLED CHILDREN: 50CENSUS: 29DATE:
06/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Harinda Gill & Khusbakht MirzaTIME COMPLETED:
11:15 AM
NARRATIVE
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Case Management inspection conducted by Licensing Program Analyst (Jennifer Hua). LPA arrived at 8:35am. At around 8:37am, LPA entered the facility (office), LPA was buzzed in. No one was in the office. Teacher Harinda Gill greeted LPA at the classroom(Pre-K) door. LPA introduced self and announced the purpose of the visit. Staff stated that director is out today. Upon entry of the classroom (Pre-K) from the office area, LPA observed 2 staff supervising 24 children, 2 of the children appeared to be school-age children, which staff confirmed. After LPA's arrival, more preschool-age children and 1 school-age child were dropped off making the Pre-K room out of ratio with 29 children and 2 staff, 3 of the 29 children were school-age. At around 9:05am, 1 staff arrived with their own school-age child, that staff pulled out the school-age children and took them to their perspective room. At around 9:20am, another staff arrived. Per assistant director she arrived at 9:30am.

Based on observation, deficiencies cited on attached 809D.

Upon receipt of this report documenting a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

Exit interview was conducted with assistant director Khusbakht Mirza, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. .
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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Document Has Been Signed on 06/21/2023 11:15 AM - It Cannot Be Edited


Created By: Jennifer Hua On 06/21/2023 at 09:43 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LA PETITE ACADEMY INC.-GRAND AVE.
FACILITY NUMBER: 198000853

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2023
Section Cited
CCR
101216.3(a)

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Teacher Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. The requirement is not met as evidenced by: LPA observed 29 children in
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Per assistant Director, will rearrange staff schedules to have them come earlier. Facility will submit copy of staff schedules to indicate sufficient staff in place to ensure compliance. Will submit by Monday 6/26/23.
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the Pre-k room supervised by 2 staff. This poses an immediate risk to the health and safety of children in care. Civil Penalty assessed as this is the 2nd citation within a 12 month period.
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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:Ana Chico
LICENSING EVALUATOR NAME:Jennifer Hua
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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