<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566200350
Report Date: 06/15/2021
Date Signed: 06/15/2021 04:59:12 PM

Document Has Been Signed on 06/15/2021 04:59 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
566200350
ADMINISTRATOR:SHANNON SUTTONFACILITY TYPE:
850
ADDRESS:85 E. BONITA DR.TELEPHONE:
(805) 526-7846
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 141TOTAL ENROLLED CHILDREN: 141CENSUS: 45DATE:
06/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Shannon SuttonTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 15, 2021 at 2:37 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. LPA met with facility Director Shannon Sutton and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There was 45 children in care at the time of the inspection.

On 6/10/2021, Director contacted Community Care Licensing (CCL) to self report an incident of a facility staff grabbing a child by the arm while they were in line. Director advised that the facility was contacted by two individual parents regarding incidents involving their children and a teacher. Director advised that facility followed up and investigated the incidents.

On 6/15/2021 at 2:52 PM, LPA Pedroza interviewed Director Sutton regarding the incident. Director advised that during the facility's follow-up of the incidents, she observed facility staff S1 grab C1 forcefully by the arm while the children were lined up via a video recording. The other staff in the classroom did not observe the incident occur because they were counting the children ensuring the children are accounted for. After reviewing the incident made by the parents and observing the video recording, it was determined the incidents were true. Director advised that S1 was placed on administrative leave on 6/9/2021 and their employment was discharged on 6/14/2021. LPA advised Director that the reported incident was a violation of personal rights.

The following CCR, Title 22, Division 12 regulation was cited: 101223(a)(3) Personal Rights.

One type B deficiency was cited today.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/15/2021 04:59 PM - It Cannot Be Edited


Created By: Francisco Pedroza On 06/15/2021 at 03:51 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 566200350

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2021
Section Cited
CCR
101223(a)(3)

1
2
3
4
5
6
7
101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse ...or aids to physical functioning.
This requirement is not met as evidence by:
1
2
3
4
5
6
7
Director advised to provide a written statement on how to prevent incidents like this in the future. Director notified children involved in the incident authorized representatives of the incident that occurred during the inspection. The proof of correction must be submitted to CCLD by 7/15/2021.
8
9
10
11
12
13
14
Parents made complaints against S1 advising they were informed by their children that they were grabbed by the arm. Director advised she observed on video S1 grabbing a child forcefully by the arm confirming the allegations. This poses a potential Health and Safety risk to clients / children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:George Mingle
LICENSING EVALUATOR NAME:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2