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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600090
Report Date: 06/23/2021
Date Signed: 10/06/2021 05:13:12 PM

Document Has Been Signed on 10/06/2021 05:13 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LA PETITE ACADEMY, INC.FACILITY NUMBER:
376600090
ADMINISTRATOR:KRISTEN COBBFACILITY TYPE:
850
ADDRESS:795 CORRAL CANYON ROADTELEPHONE:
(619) 421-5238
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 110TOTAL ENROLLED CHILDREN: 0CENSUS: 77DATE:
06/23/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kristen CobbTIME COMPLETED:
09:56 AM
NARRATIVE
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On June 23, 2021 at 09:00 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection. LPA advised Director Cobb of the meeting’s purpose. There were sixty one (61) toddlers/preschoolers (2 years to 5 years) supervised by six (6) teachers. There were sixteen (16) school aged children supervised by two (2) teachers.

LPA interviewed staff and outside sources. LPA also reviewed facility and licensing records. On 10/07/2020, Children 1 and 2 were engaged in an incident. Staff notified the parent of Child 1 of the incident via facility incident report but did not notify the parent of Child 2 of the incident. (See LIC 811 Confidential Names). Per staff, a facility incident report was completed on Child 1 but none was done on behalf of Child 2.

No deficiencies cited.



The Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. This notice was provided to staff. An exit interview was conducted with staff. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to staff; their signature on this form confirms receipt of these rights.

This is an amended version of the original report created 06/23/2021.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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 06/24/2021 11:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/23/2021 03:39 PM


Created By: JoAnn R Legaspi On 06/23/2021 at 03:25 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LA PETITE ACADEMY, INC.
FACILITY NUMBER: 376600090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
06/23/2021
Section Cited
CCR
101212(f)

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CCR 101212(f) – Reporting Requirements - " ... The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative ..." . This requirement was not met as evidenced by: C2's parent did not receive facility notification that C2's pants were pulled down; the parent
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When an incident involves two children, the director agrees to notify the parents of both children. This deficiency has been cleared.
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became aware of the incident from C2's disclosure to them. Based on interviews and record reviews, staff failed to notify C2's parent of the incident which poses as a possible risk 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:Tulam Vu
LICENSING EVALUATOR NAME:JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2021


LIC809 (FAS) - (06/04)
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