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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401075
Report Date: 08/14/2019
Date Signed: 08/14/2019 05:12:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:LA PETITE ACADEMY INC.FACILITY NUMBER:
197401075
ADMINISTRATOR:JEANA COURSONFACILITY TYPE:
840
ADDRESS:1709 E. PALMDALE BLVD.TELEPHONE:
(661) 272-3708
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:42CENSUS: 0DATE:
08/14/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Jeana CoursonTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Neal met with director, Jeana Courson for the purpose of a subsequent follow-up inspection on a Case Management - Incident that occurred on July 9, 2019.

Description of the incident: Child #1 was left sleeping in the school age classroom before it was discovered by staff that Child #1 was not on a field trip with the rest of the school age children.

Based on interviews conducted with staff and children present on the day of the incident. A lack of supervision due to inadequate name-to-face and bus assignment procedures occurred when Child #1 was left sleeping in the school age classroom.

One Type B deficiency was cited per title 22 Regulations. LIC 809D was given. Appeals rights were given.

Notice of site visit was given to be posted for 30 days. An exit interview was conducted and a copy of this report was provided to the Assistant Director on this date.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 197401075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision...No child(ren) shall be left without the supervision of a teacher at any time except...This requirement was not
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Director states that during a meeting staff reviewed proper name-to-face and bus assignment protocols. Director will submit a declaration stating changes made to prevent further incidents by POC due date.
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met as evidenced by: Child #1 was left in classroom for a length of time before discovered by staff from the preschool component which is a potential health and safety risk to children in care.
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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: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
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