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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198007062
Report Date: 01/19/2022
Date Signed: 01/19/2022 10:24:17 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2021 and conducted by Evaluator Jose Guzman
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211213082023
FACILITY NAME:LA PETITE ACADEMY, INC.FACILITY NUMBER:
198007062
ADMINISTRATOR:KAMAL GUPTAFACILITY TYPE:
830
ADDRESS:722 S. GRAND AVENUETELEPHONE:
(909) 860-4009
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:10CENSUS: 5DATE:
01/19/2022
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Director, Kamal GuptaTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Day care child sustained injury while in care.
INVESTIGATION FINDINGS:
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On 01/19/2022 at 09:07 a.m., Licensing Program Analyst (LPA) Jose Guzman conducted an unannounced complaint inspection to deliver findings of the above allegation. A risk assessment was conducted when entering the facility. LPA met with Director, Kamal Gupta, who guided LPA on a tour of the facility. There was a total of 5 children present with 2 staff.

Day care child sustained injury while in care- Complainant alleged that Child #1 (C1), who is under the age of two years old, was injured when staff removed tabletop portion connected to the highchair. Complainant also stated that C1 was not buckled into highchair and fell out of the highchair which was approximately two feet from the ground. LPA conducted interviews, reviewed records, and documented personal observations.

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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jose GuzmanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 33-CC-20211213082023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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.
FACILITY NUMBER: 198007062
VISIT DATE: 01/19/2022
NARRATIVE
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LPA conducted interviews with Staff #1 (S1), #2 (S2), #3 (S3), #4 (S4), Parent #1 (P1), and #2 (P2). S3 stated that they witnessed C1 fall to the ground and sustain an injury to the forehead. S4, who was with C1, confirmed that C1 sustained the injury to the forehead after S4 turned around to place the tabletop to the highchair elsewhere. Staff, P1, and P2 all stated that child was injured at the facility. Based on LPA observations, the highchair is approximately 11 inches from the ground. Photographs obtained from P2 showed a large size red bump to the right side of the forehead. Based on interviews conducted, records reviewed, and personal observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiency is being cited (see attached 9099D).

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Director, Kamal Gupta.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jose GuzmanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20211213082023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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.
FACILITY NUMBER: 198007062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/21/2022
Section Cited
CCR
101223(a)(2)
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Personal Rights- The licensee shall ensure that each child is ... accorded safe, ... furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by
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Director will provide a training to staff on how to care for infants when not secured in the feeding/activity chair. The director will submit training materials and staff sign-in sheet to the Department by the POC.
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Based on interviews conducted, records reviewed, and LPA observations, the licensee did not ensure safe and comfortable accommodations or equipment for children which posses a potential health & safety risk to 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: Jose GuzmanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
LIC9099 (FAS) - (06/04)
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