336301048-8-7-2025-10-CC-HMCY-DK9VDF-20250805162040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336301048
Report Date: 08/05/2025
Date Signed: 08/07/2025 02:26:24 PM

Document Has Been Signed on 08/07/2025 02:26 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		FACILITY NUMBER:	336301048
ADMINISTRATOR/ DIRECTOR:	CAFARO, SURIATI		FACILITY TYPE:	860
ADDRESS:	36555 VAN GAALE LANE		TELEPHONE:	(951) 926-1600
CITY:	WINCHESTER	STATE: CA	ZIP CODE:	92596
CAPACITY: 122	TOTAL ENROLLED CHILDREN: 109	CENSUS: 45	DATE:	08/05/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:26 PM
MET WITH:	Jacquelyn Negrete, Interim Director		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	THIS IS AN AMMENDED REPORT FROM 08/05/2025. On the date and time listed, Licensing Program Analyst's (LPA's) Hayley McCarthy and Tricia Danielson arrived at the facility to conduct a Case management incident follow-up visit on an Unusual Incident Report (UIR) received by the Department on 07/11/25. LPA met with Jacquelyn Negrete (Interim Director) to discuss the incident. A tour of the facility was granted, and census was conducted. On 07/11/25, it was self reported that Staff 1 (S1) lined her classroom up to go outside for water play and all children were present, however, child 1 (C1) hid in the classroom and stayed behind. A second count was not conducted once S1 and the class reached the playground. 29 minutes later, Interim Director, Jacquelyn Negrete was watching the cameras and found that C1 was alone in the classroom. When Interim Director confronted S1, S1 was unaware that C1 was missing. LPA met with assistant director and discussed the incident. During interview, Interim Director confirmed that C1's mother was notified and an incident report was completed and signed. S1 was later terminated for lack of supervision. Based on the information gathered, there was a violation of Title 22 Regulations found at this time, and therefore, there is one Type A deficiency cited on the 809-D page along with a civil penalty.

NAME OF LICENSING PROGRAM MANAGER: Deborah Mullen
NAME OF LICENSING PROGRAM ANALYST: Hayley McCarthy
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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	FACILITY NUMBER: 336301048
	VISIT DATE: 08/05/2025

NARRATIVE

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THIS IS AN AMMENDED REPORT FROM 08/05/2025.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

An exit interview was conducted, and a copy of this report was provided to Jacquelyn Negrete (Interim Director). A Notice of Site Visit was issued and the Licensee understands that it must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Deborah Mullen
NAME OF LICENSING PROGRAM ANALYST: Hayley McCarthy
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/07/2025 02:28 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/07/2025 12:39 PM

Created By: Hayley McCarthy On 08/05/2025 at 04:01 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LA PETITE ACADEMY	FACILITY NUMBER: 336301048
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/05/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/13/2025 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision (1)No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.	1 2 3 4 5 6 7	S1 was terminated. On August 13, 2025 Interim Director and District Manager will conduct a training on safety regulations and face to name procedures. Once complete, Interim Director will send proof of completed training.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: C1 was left alone in a classroom for 29 minutes without supervision.	8 9 10 11 12 13 14	THIS IS AN AMMENDED REPORT FROM 08/05/2025.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Deborah Mullen
NAME OF LICENSING PROGRAM MANAGER:

	Hayley McCarthy
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

LIC809 (FAS) - (06/04)

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