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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006287
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:40:52 PM

Document Has Been Signed on 09/19/2024 02:40 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, 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: 61CENSUS: 37DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Daisy Lemus, Associate DirectorTIME VISIT/
INSPECTION COMPLETED:
02:24 PM
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A case management visit to the facility was made today by Licensing Program Analyst (LPA) Y. Yang. During an inspection for an unrelated matter on 09/19/24, it was verbally reported to the LPA by the center’s associate director, Daisy Lemus, that on 09/16/24, there was a lack of supervision incident at the facility involving three preschool age children (child C1-C3) being left unsupervised while on the center’s main play yard. The associate director stated that she was not present at the facility on the day of the incident and does not have all the details of the incident at this time. Lemus stated that this incident occurred under the former center director, Jajuan Jaymes, whose last day working at the center was on 09/17/24.

Due to insufficient information at this time, this incident requires further investigation by the Department. Additional interviews will be completed and a follow-up visit will be made on a later date. Per Title 22 regulations, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. The facility shall submit the written unusual incident report (UIR) to the Department within seven days following the occurrence of the event. This incident was not reported to the Department by telephone or fax within the Department's next working day and during its normal business hours.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with associate director, Daisy Lemus. There were no Title 22 deficiencies cited during today's inspection.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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