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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419097
Report Date: 07/17/2025
Date Signed: 07/17/2025 01:29:18 PM

Document Has Been Signed on 07/17/2025 01:29 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PETITE SCHOOL HOUSEFACILITY NUMBER:
197419097
ADMINISTRATOR/
DIRECTOR:		SALMEENA ZAKIFACILITY TYPE:
850
ADDRESS:17643 ROSCOE BLVD.TELEPHONE:
(818) 708-8766
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 182TOTAL ENROLLED CHILDREN: 115CENSUS: 68DATE:
07/17/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:05 AM
MET WITH:Marelyn Morales, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 07/17/2025 at 08:10 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Annual Required Inspection. Facility is located at 17643 Roscoe Blvd., Northridge, CA. 91325. LPA identified self and met with Mayra Tovar, Teacher/Office Assistant. LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection. Marelyn Morales, Assistant Director arrived shortly after.

Facility Representative (FR) Marelyn Morales, Assistant Director allowed entry to facility and provided LPA a guided tour of inside and outside of the facility. The facility is currently licensed for a capacity of 182, per FR they currently have 115 enrolled. The facility hours of operation are currently Monday thru Friday from 06:30 AM to 06:00 PM.

Required postings were observed posted in Main Office and each classroom.

The facility is made up of seven (7) classrooms. Van Gogh Classroom, ages 2.5 year to 3 year old with 2 staff, Picasso Classroom ages 2 year olds with 3 staff, Monet Classroom, ages 3 year olds to 4 year olds with 2 staff, Dali Classroom, ages 2.5 year olds to 3 year olds with 1 staff, Matise Classroom, ages 3 year olds to 4 year olds with 2 staff, Da Vinci Classroom, ages 4 year olds to 5 year olds with 2 staff and Cezanne Classroom, ages 5 year olds to 6 year olds with 2 staff. There is 1 floater staff to cover staff lunches and breaks.

Beginning at 08:30 AM, LPA observed the following in all the classrooms. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were cubbies used for Page 1 of 4
Rita RamosTELEPHONE: (424) 301-3061
Elicia CalvilloTELEPHONE: (424) 301-3016
DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/17/2025 01:29 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 07/17/2025 at 12:46 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the facility did not complete the Lead Water Testing by the due date which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2025
Plan of Correction
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Assistant Director confirmed the facility is in the process of scheduling Leat Water Testing and will provide the results to LPA by the plan of correction due date 08/18/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (424) 301-3061
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (424) 301-3016
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2025


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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097
VISIT DATE: 07/17/2025
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each child to store their belongings. Drinking water was readily available with individual sippy cups labeled with each child’s name and there are pitchers of water and/or water fountains available in the classrooms to refill the individual sippy cups. The restroom(s) were inspected for safety and sanitation. Located in each classroom, there were age-appropriate sinks and toilets and there was available water, water temperature was appropriate, toilet paper was provided. All classrooms are equipped with a telephone and heating, lighting, and ventilation were evaluated for safety and comfort.

LPA observed first aid kits located in each classroom and inventoried for necessary supplies. LPA observed that the cabinets where the first aid kits are stored is labeled. LPA observed devices on the classroom ceiling in each classroom, per FR the devices are a carbon monoxide detector and a smoke detector. LPA observed smoke detector via fire alarm. Disaster drill log was available, and the last disaster drill was conducted on 06/03/2025. Per FR, isolation area for sick children is in the office. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA observed cleaning solutions stored in a high cabinet in the restrooms.

Beginning at 09:30 AM, LPA toured the outdoor play area and observed playground equipment in safe conditions, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained and is free of hazards. LPA observed that there are areas of the rubber material covering the ground (photos taken) that need repair. Children have access to three (3) climbing structures located in the play area and there is rubber material underneath and surrounding the structures to absorb falls. There is adequate shade in the play yard. The children have access individual sippy cups, pitchers of water for refills, and/or water fountains for refills; for drinking water during outdoor play. LPA advised that no children shall be left without supervision at any time.

There is a swimming pool on the premises. During the water play, there is a life guard station inside the gated pool. LPA observed a pool, the fence is in good repair, completely surrounds the pool, is designed and installed so children could not remove any portion, is at least 5 feet high, is constructed so that it does not obscure the pool from view. Children cannot easily climb over the fence, there is no window or door with direct access. The gate swings away from the pool, self closes, is self-latching, and the self-latching device is located no more than 6 inches from the top. There are no gaps of more than 4 inches, and the bottom of the fence is no more than 4 inches from the ground. LPA observed additional safety pool items, a life ring Page 2 of 4
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097
VISIT DATE: 07/17/2025
NARRATIVE
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and a rescue pole with a body hook.

Beginning at 09:45 AM, LPA did observe the kitchen area/ food preparation area, per FR snacks and meals are provided by the facility. Snack and meal menus are posted in each classroom. LPA did not observe any open containers in the refrigerator. Food preparation was inspected for safety and sanitation, hazardous items including poisonous cleaning compounds were stored inaccessible to children with the use of door lock to the kitchen.



Beginning at 10:00 AM, staff and children’s records were reviewed for completeness. An inspection of the required forms was made and documented on LIC 857 for children and LIC 859 for staff. There was 1 of 5 staff records missing qualification transcripts. Criminal Record Clearances were reviewed for adults. CPR card expires on 02/2027 for Assistant Director. Inspection of required forms were discussed.

LPA observed that teacher-child ratios were maintained, and staff names were recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed 68 of 68 children signed in at time of inspection. Personal Rights of children were observed by LPA.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of "medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY} and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care­ centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097
VISIT DATE: 07/17/2025
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LPA verified that facility did not complete the lead testing prior to their deadline in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the
email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspection process @dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community -care-licensing /inspection-process.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care­ licensing/subscribe and select the Child Care option to receive email communication.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there is one (1) Type B deficiency citation for section 101700(b) Written Directives for Lead Testing and a plan of correction is due 08/18/2025.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Marelyn Morales, Assistant Director, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
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