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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300565
Report Date: 03/06/2025
Date Signed: 03/06/2025 12:52:31 PM

Document Has Been Signed on 03/06/2025 12:52 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMY.INCFACILITY NUMBER:
336300565
ADMINISTRATOR/
DIRECTOR:		SURIATI CAFAROFACILITY TYPE:
850
ADDRESS:36555 VAN GAALE LANETELEPHONE:
(951) 926-1600
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: DATE:
03/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:59 AM
MET WITH:Jacquelyn Negrete, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On March 6, 2025, at 11:59 AM, Licensing Program Analyst (LPAs) Hayley McCarthy and Jesse Gardner made an unannounced complaint visit in reference to complaint #10-CC-20250303115035. LPAs met with Assistant Director Jacquelyn Negrete, and toured the facility and took a census.

During a tour of the facility, LPAs noted two regulatory violations of Title 22 as follows:

1. LPAs observed a dance teacher alone with 3 children while they were providing services without the supervision of a qualified teacher.

2. In the 2's classroom, LPAs observed a mop bucket with water in the bathroom accessible to children.

An exit interview was conducted with Assistant Director Jacquelyn Negrete. A copy of this report, LIC809D (Deficiency page) and appeal rights were issued, along with a Notice of Site visit. This report shall be public record for three years.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Hayley McCarthy
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 03/06/2025 12:52 PM - It Cannot Be Edited


Created By: Hayley McCarthy On 03/06/2025 at 12:28 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: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for providing care and supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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Director will submit a written statement that supervision will be provided by a qualified teacher when the outside activities are being provided by a 3rd party vendor. Proof of correction will be submitted to CCL by 3/20/25.
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Based on observation the licensee did not comply with the section cited above in that LPA observed a dance teacher and a sports teacher who came in and provided services to children without the supervision of a qualified teacher which poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/20/2025
Section Cited
CCR101238(a)(2)

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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. (2) The licensee shall safely dispose of water and any disinfectants/solutions that have been used for cleaning. This requirement is not met as evidenced by:
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Director will remove the mop bucket and submit proof of correction to CCL by 3/20/25.
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Based on observation, the licensee did not comply with the section cited above in that a mop bucket with water was observed in the bathroom accessible to children in the two year old room which poses/posed a potential health, safety or personal rights risk to persons 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:Deborah Mullen
LICENSING EVALUATOR NAME:Hayley McCarthy
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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