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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006287
Report Date: 11/13/2024
Date Signed: 11/13/2024 02:24:26 PM

Document Has Been Signed on 11/13/2024 02:24 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LA PETITE ACADEMY - PRESCHOOL/WINDSORFACILITY NUMBER:
493006287
ADMINISTRATOR/
DIRECTOR:
LEMUS, DAYSIFACILITY TYPE:
850
ADDRESS:9451 SOUTH BROOKS ROADTELEPHONE:
(707) 838-0549
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 92TOTAL ENROLLED CHILDREN: 62CENSUS: 45DATE:
11/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:54 AM
MET WITH:Maggie Petersen, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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A Case Management inspection was conducted at the facility today by Licensing Program Analyst (LPA) Y. Yang in response to an Unusual Incident Report (UIR) received by the Department 10/09/2024 involving child C1. During today’s visit, the LPA met with the center’s assistant director, Maggie Petersen to discuss the incident report submitted by center director, Daysi Lemus. Director Lemus reported that on 09/24/24, child C1’s authorized representative reported finding “eight small pebbles” in C1’s stool. Director Lemus reported that C1’s authorized representative suspects that C1 ingested the small pebbles while on the play yard at the facility. Director Lemus reported that although she is not certain that the child ingested the pebbles while at the facility, staff have observed C1 attempting to place small items into their mouth. Director Lemus reported that C1’s teachers are providing additional supervision to C1 and have been reminded about choking hazards in the classroom and on the play yard.

During today's case management visit, the LPA interviewed staff and reviewed with the assistant director the facility's child supervision policies and made best practice recommendations the regarding the physical plant at the facility. The LPA inspected the preschool play yards and did not observe any pea gravel or any other forms of landscape rock on the play yards. The facility uses wood chip cushioning and artificial turf on the playgrounds.

Based on available information, it has been determined that there is no evidence of violations of regulations that occurred; the LPA was unable to substantiate that the child consumed the gravel while at the facility. This report was read and reviewed with Assistant Director Petersen. There were no Title 22 violations cited as a result of today's case management visit. The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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