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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401075
Report Date: 08/01/2024
Date Signed: 08/01/2024 01:53:13 PM


Document Has Been Signed on 08/01/2024 01:53 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: 18DATE:
08/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Jeana Courson, Director TIME COMPLETED:
02:13 PM
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On 08/01/24 at 12:10PM, 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 07/25/2024. LPA disclosed the purpose of the inspection to the facility representative. When LPA arrived at the facility there were 18 school age children in care, with 2 teachers.

Description of Incident: On 07/25/2024, while on a field trip at Tierra Bonita Park, child #1 was playing at the splash pad, and child #1 ran, slipped, and fell on their chin causing a large cut. Child #1 was transported to Palmdale Regional Hospital to receive medical attention. Child #1 received stitches on their chin.

During this inspection, LPA interviewed staff, child #1, and other day care children who witnessed the incident. From interviews conducted, it was revealed that staff had initially advised the school-age children not to run, as water activities were planned for the field trip location. When the daycare children arrived at the splash pad, child #1 became excited, and tripped over an in-ground metal vent near the splash pad. Gauze and tape were promptly applied to child #1's chin by Teacher #2, and the parents were immediately notified. At the parents' request, child #1 was then transported to Palmdale Regional Hospital by Teacher #2. The incident was determined to be accidental, and 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: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024
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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