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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006287
Report Date: 09/27/2024
Date Signed: 09/27/2024 02:46:58 PM

Document Has Been Signed on 09/27/2024 02:46 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:
09/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:44 AM
MET WITH:Daysi Lemus, Acting Center DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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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, lack of supervision incident involving child C1, C2, and C3 and the center’s former director Jajuan Jaymes (staff S1) that occurred on 09/16/24. During today’s visit, the LPA met with the acting center director, Daysi Lemus (staff S2) to discuss the incident. Staff S2 stated that she was not present at the center at the time of the reported incident but is familiar with the incident after interviewing staff who were on site at the time.

On 09/23/24, it was reported via written unusual incident report (UIR) and email by facility representative Cari Huff (staff S3) that on 09/16/24 at approximately 10:25am, staff S1, who was with seven preschool-age children on the center’s main play yard, escorted four children inside the building to use the bathroom and left child C1-C3 on the play yard. Staff S3 reported that S6 “Saw the children immediately and told her co teacher [Staff S5].” Staff S3 reported that the teachers then opened the gate to their play yard and instructed C1-C3 to join them on their play yard until S1 returned “A few moments later.” Staff S3 reported that she was not on site at the time of this incident. The UIR did not provide any information on the immediate actions taken by the center or include any additional comments. Staff S3 reported that S1 is no longer employed by the center.

Based on interviews conducted by the LPA with staff S1-S6 on 09/19/24 and 09/27/24, all staff members interviewed stated that they do not corroborate the narrative of events described in the UIR written and submitted by S3. The LPA interviewed S5 and S6 regarding their recollection of this event. Staff S5 and S6 both stated that they did not immediately observe C1-C3 and estimate that C1-C3 were without the direct supervision of a staff member for approximately five minutes while on the center’s fully fenced play yard. Staff S5 and S6 both stated that they were supervising the children from their assigned classroom on the adjacent play yard and was not aware that S1 was leaving the three children on the play yard. Staff S6 informed the LPA that S1 stated that the reason why C1-C3 were intentionally left without supervision on the play yard was due to C1-C3 not wanting to go inside the building to use the bathroom with the rest of their classmates. Staff S5 and S6 stated that S1 returned to the play yard with the four other children approximately three minutes after C1-C3 were brought to their play yard. Staff S5 and S6 stated that C1-C3 did not appear to be upset or in distress.

Based on available information, it has been determined that adequate supervision was not provided to child C1-C3 during the incident on 09/16/2024. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. This report was read and reviewed with the acting center director, Daysi Lemus. Notice of site visit shall be posted for 30 days. Appeal rights provided.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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Document Has Been Signed on 09/27/2024 02:46 PM - It Cannot Be Edited


Created By: Yang Yang On 09/27/2024 at 01:04 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LA PETITE ACADEMY - PRESCHOOL/WINDSOR

FACILITY NUMBER: 493006287

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2024
Section Cited
CCR
101229(a)(1)

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Care and Supervision. 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 was not met as evidenced by: based on interviews conducted by the LPA with staff S1-S6 on 09/19/24 and 09/27/24, it was corroborated that on 09/16/24 at approximately 10:25am, child C1, C2, and C3 were left without supervision of a teacher for approximately five minutes while on the center's main play yard before being reunited with their class. This presents a potential threat to the health and safety of children in care.
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The acting center director stated that the center will be conducting a training for all staff in order to provide additional training to staff on providing care and supervision to children and handling transitions. The acting center director stated that she will submit a summary of the training along with proof of attendance to the LPA by 10/11/24.

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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:Alexis Hollon
LICENSING EVALUATOR NAME:Yang Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2024


LIC809 (FAS) - (06/04)
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