197401088-2-23-2021-12-CC-MJAA-BYJ2R6-20210223163657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197401088
Report Date: 02/23/2021
Date Signed: 02/23/2021 04:37:49 PM

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:	197401088
ADMINISTRATOR:	SAMANTHA SCALISE		FACILITY TYPE:	840
ADDRESS:	28041 SECO CANYON		TELEPHONE:	(661) 297-0977
CITY:	SAUGUS	STATE: CA	ZIP CODE:	91350
CAPACITY:	28	CENSUS: 0	DATE:	02/23/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Ashley Perez, Director		TIME 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 02/23/2021 Licensing Program Analyst (LPA) Monique Ayala and Regional Manager (RM) Scott Herring conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred on 02/22/21. The Palmdale Regional Office received the telephone incident report on 02/23/21. Upon arrival, LPA and RM met with director. Based on the information received on 02/23/21, an SUV ran into the facility wall toddler classroom wall that faces the facilities parking lot at approximately 4:32PM on 02/22/21. When the SUV ran into the facility wall a bookshelf located in the toddler room fell on top of 2 children. Staff member Kim Shepheard called 911 and paramedics arrived shortly after the accident. At the time of the incident there were 3 children and 1 staff in the toddler classroom. Three day care children sustained minor injuries; however, three of the children were transported to Northridge Hospital as a precautionary measure. The facility followed proper safety and emergency protocols and notified the children's parents as well as notified the licensing agency. The facilities plans to reopen safely on March 08, 2021. The toddler room is currently under construction. While construction is taking place, children and staff will not be in contact with the construction workers. The construction workers will enter and exit through the toddler classroom.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica Ayala	TELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LA PETITE ACADEMY INC.	FACILITY NUMBER: 197401088
	VISIT DATE: 02/23/2021

NARRATIVE

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LPA and RM toured the facility and observed the property wall located in the toddler classroom that faces the parking lot of the facility. Due to the facility damage, the toddler classroom is closed and will reopen on 03/08/2021. During this inspection a copy of the facility roster was obtained. At this time, there are no Title 22 violations observed.

The facility plans to assist their staff with trauma informed resources and to provide counseling support to staff and parents. Additionally, the facility plans to resume operation of the facility on 02-24-2021. The toddlers will be relocated to other areas of the facility where construction is not taking place.

An Emergency waiver request will be submitted to the Department later this afternoon to utilize preschool activity space to temporarily accommodate up to 6 of the infant-toddlers.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted, a copy of this report was emailed to the director along with the notice of site visit must be posted for 30 days upon receipt.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica Ayala	TELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

LIC809 (FAS) - (06/04)

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