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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006287
Report Date: 01/07/2025
Date Signed: 01/07/2025 05:38:25 PM

Document Has Been Signed on 01/07/2025 05:38 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: 49CENSUS: 45DATE:
01/07/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:33 AM
MET WITH:Autumn Shafer, Acting Center DirectorTIME VISIT/
INSPECTION COMPLETED:
03:49 PM
NARRATIVE
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An unannounced case management visit was made to the facility by Licensing Program Analysts (LPAs) Y. Yang and J. Agbayani. It was reported to the Department by a concerned party that construction work was being performed on the playground(s) of the childcare center. The Department was not given prior notification of any proposed changes at the facility, which is required by Title 22 regulations 101237(a).

During today’s inspection visit, the LPAs met with the acting center director, Autumn Shafer and assistant director, Maggie Petersen. Director Shafer stated that her first official day working at this facility was on 01/06/2025. A review of the personnel report on 01/07/25 indicates that Director Shafer has received criminal record and child abuse index clearances or exemptions but is not associated to this facility. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During the LPA’s tour of the premises, the LPAs observed two roll-off dumpsters located in the front parking lot by the main office. Upon further inspection, the LPAs observed that two preschool play yards are currently under active construction. The LPAs observed that the fenced playground in the far western corner of the yard contained a newly assembled play structure. The LPAs observed that the manufacturer’s sticker on the play structure indicate that the play structure is designed for children ages five-to-twelve years of age. This facility is licensed for preschool age children ages two-to-entry into kindergarten and also has a toddler component. The facility representative was made aware that no child under age five shall be permitted to use this play structure. Additionally, the LPAs observed a second, newly constructed play structure in the play yard closest to the “Early Preschool” and “Preschool” classrooms. The manufacturer’s sticker on this play structure indicate that it is designed for children ages two-to-five years of age.

(Continued on LIC 809-C)

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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 01/07/2025 05:38 PM - It Cannot Be Edited


Created By: Yang Yang On 01/07/2025 at 11:39 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
, 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: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/08/2025
Section Cited
CCR
101238(e)

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Buildings and Grounds. All licensees shall ensure the inaccessibility of pools, including swimming pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds or similar bodies of water, through a pool cover or by surrounding the pool with a fence.

This requirement was not met as evidenced by: Based on the LPA's observations on 01/07/25 at 11:15am, during an outdoor play yard walkthrough with Director Shafer and Assistant Director Petersen, the LPAs observed building materials, children’s play equipment (sand and water tables), and other plastic play furniture not intended for water use that have accumulated water at least several inches deep.

This poses an immediate health and safety risk to the children in care.
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This deficiency has been cleared during today's inspection. Director Shafer and Asssitant Director Petersen drained the bodies of water onto the play yard and removed drain plugs when applicable.

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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:Megan Aviles
LICENSING EVALUATOR NAME:Yang Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/07/2025 05:38 PM - It Cannot Be Edited


Created By: Yang Yang On 01/07/2025 at 01:48 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: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/08/2025
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by: Based on a review of the personnel report on 01/07/25, Acting Center Director Shafer has received criminal record and child abuse index clearances or exemptions but is not associated to this facility.
This poses a potential health, safety or personal rights risk to persons in care.
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Acting Center Director Shafer stated that she will transfer her clearance to this facility and notify the LPA by close of business 01/08/25.
Type B
01/21/2025
Section Cited
CCR
101237(a)

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Alterations to Existing Buildings or New Facilities. Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s). This requirement was not met as evidenced by: The Department was not given prior notification of any proposed changes at the facility. This poses a potential health, safety or personal rights risk to persons in care.
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The facility representative will submit a written document to the Department describing the scope of the project along with details regarding how the center plans to meet outdoor play regulations while construction is ongoing.

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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:Megan Aviles
LICENSING EVALUATOR NAME:Yang Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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/WINDSOR
FACILITY NUMBER: 493006287
VISIT DATE: 01/07/2025
NARRATIVE
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On the two playgrounds, the LPAs also observed construction materials, hand tools, screws and fasteners, and other building materials. The facility representative stated that this area is currently not being used for childcare due to ongoing construction, however, the Department did not receive proper documentation from the facility indicating that both play yards are temporarily off limits. The facility representative stated that she did not have an estimated completion date for the construction. The LPAs observed building materials, children’s play equipment (sand and water tables), and other plastic play furniture not intended for water use that have accumulated water at least several inches deep. The facility representative stated that preschool children currently have access to a play yard that is adjacent to the two other play yards undergoing construction and is separated by a four-foot-tall chain link fence and gate. The toddler play yard remains for toddler use only.

The following violations of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. A civil penalty will be assessed. This report was read and reviewed with the acting center director, Autumn Shafer. Notice of site visit shall be posted for 30 days. Appeal rights provided. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of children newly enrolled at the facility for the next 12 months from the date of this report. Parents/guardians must sign form LIC 9224 to be kept in each child's file.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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