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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300565
Report Date: 02/16/2024
Date Signed: 02/16/2024 12:55:56 PM

Document Has Been Signed on 02/16/2024 12:55 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: 91DATE:
02/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Assistant Director Jacquelyn NegreteTIME COMPLETED:
10:30 AM
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On February 16, 2024, Licensing Program Analysts (LPA), Jessica Rubio and Jesse Gardner arrived unannounced to La Petite Academy Inc (CCC), and met with Assistant Director Jacquelyn Negrete for a case management visit as a follow up to a complaint regarding an uncovered electrical outlet in one of the classrooms. During a tour of the facility on 1/17/2024, LPA observed an uncovered electrical outlet in the Twos classroom. In addition to observing the uncovered outlet, LPA also observed a light up table with an accessible power cord directly in the area under the outlet. Interviews with the Director and staff along with photographic evidence revealed that children do play with the power cord and the electrical outlet, which poses a potential safety hazard.

The facility is being cited for Title 22 Regulation Section 101238(a) Buildings and Grounds. See LIC 809D for cited deficiency. An exit interview was conducted, and a copy of this report and appeal rights were reviewed with and provided to Assistant Director Jacquelyn Negrete. 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: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2024
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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Document Has Been Signed on 02/16/2024 12:55 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 02/16/2024 at 10:48 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
The above requirement was not met as evidenced by:
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The facility replaced the missing electrical outlet cover and moved the table to the other side of the room. LPA observed these corrections when on site.
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Based on observation of an uncovered accessible electrical outlet and power cord in the Two's classroom which poses a potential health, safety, and or personal rights ris 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: 02/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2024


LIC809 (FAS) - (06/04)
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