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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006287
Report Date: 06/27/2024
Date Signed: 06/27/2024 11:57:40 AM

Document Has Been Signed on 06/27/2024 11:57 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LA PETITE ACADEMY - PRESCHOOL/WINDSORFACILITY NUMBER:
493006287
ADMINISTRATOR/
DIRECTOR:
JAMIE POMAFACILITY TYPE:
850
ADDRESS:9451 SOUTH BROOKS ROADTELEPHONE:
(707) 838-0549
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 92TOTAL ENROLLED CHILDREN: 83CENSUS: 61DATE:
06/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Jennifer "Jenny" Wittry, Acting Center DirectorTIME VISIT/
INSPECTION COMPLETED:
12:11 PM
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An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang in response to a self reported incident involving child C1. During today’s visit, the LPA met with the acting center director, Jennifer "Jenny" Wittry to discuss the incident.

It was reported by acting center director Wittry that on 06/25/24, while transitioning from a classroom to the facility's outdoor play yard, child C1 tripped and fell while running towards the play yard and cut and scraped their upper lip on a bike. Wittry stated that first aid was provided and the child's authorized representative was notified. Wittry stated that the child's authorized representative transported the child to be examined by a medical professional that same day. During today's case management visit, the LPA inspected the playground and did not observe any evidence of physical plant issues on the playground.

During this visit, technical assistance was also provided to the acting director regarding the topics of reporting requirements, Title 22 regulations, and best practices.

This self reported incident was reported to CCLD as required per regulations. Based on available information, there is not a preponderance of evidence to suggest that the incident occurred due to any violation of regulations. This report was read and reviewed with the acting center director, Jenny Wittry. Notice of site visit shall be posted for 30 days.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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