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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300565
Report Date: 06/02/2023
Date Signed: 06/02/2023 12:58:04 PM

Document Has Been Signed on 06/02/2023 12:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMY.INCFACILITY NUMBER:
336300565
ADMINISTRATOR:SURIATI CAFAROFACILITY TYPE:
850
ADDRESS:36555 VAN GAALE LANETELEPHONE:
(951) 926-1600
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 88DATE:
06/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Suriati CafaroTIME COMPLETED:
01:05 PM
NARRATIVE
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On June 2, 2023 at 10:30 am, Licensing Program Analyst (LPA) Jessica Rubio arrived unannounced to the La Petite Academy, Inc. (CCC) to conduct a case management visit due to an unusual incident report (UIR) that CCC submitted for an incident that occurred on 5/11/2023. The UIR reported a parent of child (C1) seeing a teacher (S1) push C1's head down onto a cot during nap time and another teacher (S2) grab C1 by the arm to sit C1 down in a chair. LPA met with Director (AD) Suriati Cafaro and conducted a tour and census of the facility. During the visit, LPA conducted interviews with Director and two staff (S1 and S2). Interviews revealed that C1's parent saw the incidents occur over the live-stream classroom camera. Director stated she did not have access to review the video footage, however, District Manager (DM), Deanne McCashland did review it. LPA attempted to contact DM by phone, however DM did not answer. Interviews with staff revealed although C1 did not want to remain in the cot or at the table, S1 did try to keep C1 in the cot for nap time and S2 tried to keep C1 at the table for snack time. S1 denied pushing C1's head down onto the cot, however, did state S1 was kicking the wall and S1 took C1's leg and placed it back onto the mat as well as held C1's hands when C1 tried to get into S1's pockets. S2 stated she placed C1 in a chair by grabbing C1 by C1's bicep. Interviews also revealed staff believed that children had to remain in their cots at nap time and at the table during snack time, even if the child does not want to. LPA determined the facility is in violation of Title 22 Regulation Section 101223 Personal Rights. See LIC 809-D for cited deficiencies.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Director Suriati Cafaro. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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 06/02/2023 12:58 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 06/02/2023 at 12:19 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LA PETITE ACADEMY.INC
FACILITY NUMBER: 336300565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2023
Section Cited
CCR
101223

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(a) The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidence by:
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Director stated all staff will be trained on Personal Rights and will provide proof to LPA.
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Staff forcing C1 to remain on the cot and at the table which poses a potential risk to health, safety and/or personal rights to 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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