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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623848
Report Date: 03/11/2024
Date Signed: 03/11/2024 09:45:01 AM

Document Has Been Signed on 03/11/2024 09:45 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LA PETITE ACADEMY - EUREKAFACILITY NUMBER:
313623848
ADMINISTRATOR:COURTNEY WILLIAMSFACILITY TYPE:
850
ADDRESS:1800 EUREKA RDTELEPHONE:
(916) 783-7700
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 65DATE:
03/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Courtnet WilliamsTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Jeremey McClain met with facility representative Courtney Williams for an unannounced Case Management Inspection regarding an Unusual Incident Report.

Upon arrival, LPA observed 65 children, supervised by 7 staff members.

It was reported that on 03/08/2024, child 1 was administered and epinephrine injection after they suffered an allergic reaction to food that was served that day. 911 was called and the child was transported to the hospital and given further treatment.

LPA reviewed the child’s file and conducted interviews with the teacher and the cook. Although aware of the child’s dietary restriction, there was a miscommunication between staff and the cook, of which child the substitute meal was for. This is the first reported incident of a child suffering an allergic reaction while in care.
LPA discussed a plan for communication between the cook and staff regarding dietary restrictions and allergens. The cook stated that they will now label all food with children’s names if they have a dietary restriction.

An exit interview was conducted, and this report was reviewed with facility representative Courtney Williams. A Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2024
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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