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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401075
Report Date: 05/10/2024
Date Signed: 05/10/2024 02:35:18 PM


Document Has Been Signed on 05/10/2024 02:35 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



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: DATE:
05/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:17 PM
MET WITH:Jeana Courson, Director TIME COMPLETED:
02:30 PM
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On May 10, 2024, at 1:17 p.m., Licensing Program Analyst (LPA) Justeene Tamayo met with Director, Jeana Courson, who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for a UIR received at Palmdale RO on 05/03/24. LPA disclosed the purpose of the inspection to the facility representative. When LPA arrived at the facility there were 12 school age children in care with 2 lead teachers.

Description of Incident: On 05/01/24 child #1 tripped and fell outside on the play equipment, and hit their chin and chipped their tooth.

During the inspection LPA interviewed staff, child #1, and other relevant parties. From interviews conducted, it was revealed child #1 fell and tripped on accident. Ice was immediately applied to child #1 chin, and parents were immediately notified. The occurrence was accidental, no deficiencies have been cited at this time.

An exit interview was conducted, a copy of this report was provided to Director, along with her appeal rights and Notice of Site Visit.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
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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