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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006287
Report Date: 01/30/2025
Date Signed: 01/30/2025 12:45:08 PM

Document Has Been Signed on 01/30/2025 12:45 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: 39DATE:
01/30/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:48 AM
MET WITH:Autumn Shafer, Acting Center DirectorTIME VISIT/
INSPECTION COMPLETED:
11:59 AM
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A case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang at the request of the facility to inspect and approve a newly constructed play structure in the "Two's Yard" and provide technical assistance. The LPA observed that the manufacturer's label on the play structure indicate that the play structure is rated for children ages two-to-five years of age. During a previous case management visit on 01/22/25, the LPA inspected the two other preschool play yards (TK and EPS). The play structure on the TK yard is rated for children ages two-to-twelve years of age and the play structure in the EPS yard is rated for children ages two-to-five years of age. During the previous inspection visit, the LPA requested that the facility provide information on the cushioning material used in the fall zone under the play structures as it was not immediately clear during the inspection visit. Per the details provided by the facility representative, the cushioning material is a two inch thick, "Tiger Playground Pad" used as "an underlayment layer for playground turf to provide additional safety and comfort for children playing and in case of an accidental fall" and is tested at a theoretical height of six feet with landscape turf infilled with 2lbs/sq.ft of acrylic coated sand tested over compacted aggregate. The facility representative confirmed that the cushioning material was installed according to manufacturer direction.

There have been no other changes to the facility's physical plant or the footprint of the outdoor play area as of today's date and no additional changes shall be made without prior notification and approval of the Licensing agency and the local building division. The play structures in the three play yards (TK, EPS, and Two's Yard) and the fall cushioning material have been inspected and approved for use effective today's date. The facility representative agrees to use and maintain the play structures and cushioning material per manufacturer's direction.

This report was read and reviewed with the acting center director, Autumn Shafer. There were no Title 22 violations cited during 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: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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