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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000854
Report Date: 06/21/2023
Date Signed: 06/21/2023 11:12:43 AM


Document Has Been Signed on 06/21/2023 11:12 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LA PETITE ACADEMY INC.-GRAND AVE.FACILITY NUMBER:
198000854
ADMINISTRATOR:KAMAL GUPTAFACILITY TYPE:
840
ADDRESS:722 SO. GRAND AVE.TELEPHONE:
(909) 860-4009
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:28CENSUS: 5DATE:
06/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Harinder GillTIME COMPLETED:
11:15 AM
NARRATIVE
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Case Management inspection conducted by Licensing Program Analyst (Jennifer Hua). LPA arrived at 8:35am. At around 8:37am, LPA entered the facility (office), LPA was buzzed in. No one was in the office. Teacher Harinda Gill greeted LPA at the classroom(Pre-K) door. LPA introduced self and announced the purpose of the visit. Staff stated that director is out today. Upon entry of the classroom (Pre-K) from the office area, LPA observed 2 staff supervising 24 children, 2 of the children appeared to be school-age children, which staff confirmed. After LPA's arrival, more preschool-age children and 1 school-age child were dropped off making the Pre-K room out of ratio with 29 children and 2 staff, 3 of the 29 children were school-age. At around 9:05am, 1 staff arrived with their own school-age child, that staff pulled out the school-age children and took them to their perspective room. At around 9:20am, another staff arrived. Per Assistant Director Khusbakht Mirza, she arrived at 9:30am.

Based on observation, deficiencies cited on attached 809D.

Upon receipt of this report documenting a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

Exit interview was conducted with teacher Khusbakht Mirza, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. .
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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Document Has Been Signed on 06/21/2023 11:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: LA PETITE ACADEMY INC.-GRAND AVE.
FACILITY NUMBER: 198000854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2023
Section Cited
CCR
101538.3(b)

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Indoor Activity Space for School-Age Children. In combination programs, indoor activity space provided for school-age child care center children shall be physically separated from space provided for infant care and child care center children. The requirement is not
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Per assistant director, will rearrange staff schedule to start earlier and have a staff for the school-age classroom. Will submit copy of staff schedules to the Department by Monday 6/26/23.
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met as evidenced by: LPA observed 2 school-age were co-mingled with the preschool children in the Pre-K when LPA arrived. This poses an immediate risk to the health and safety of 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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
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