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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334801219
Report Date: 10/12/2023
Date Signed: 10/12/2023 06:08:22 PM


Document Has Been Signed on 10/12/2023 06:08 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
334801219
ADMINISTRATOR:WENDY SERNAFACILITY TYPE:
840
ADDRESS:11100 COLLETT AVENUETELEPHONE:
(951) 688-1313
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:42CENSUS: 13DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Wendy SernaTIME COMPLETED:
06:17 PM
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Licensing Program Analyst (LPAs) Raymond Moorehead, Claudia Caywood, and Licensing Program Manager (LPM) Aaron Ross conducted a required/annual inspection as part of a compliance review. A tour of the inside and outside of the facility was granted and the following was observed and/or noted:
This is a combination center and the other licensed program (Licensee # - 334801218) was also inspected on this date.
A review of staff and children's records were conducted as part of this evaluation.
· The licensee/director is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization (only if changes have been made)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made)
· The following items have been posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu
· The facility is operating with the limits as stated on the license.
· Ratios are being met during this inspection.
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 334801219
VISIT DATE: 10/12/2023
NARRATIVE
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· There are no weapons present at the facility as stated by Director Wendy Serna.
· There are no accessible bodies of water present at this time. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Supply of drinking water in the indoor activity space is present.
· Medications are stored where inaccessible to children.
· Hazards are stored where inaccessible to children which include disinfectants, cleaning solutions and other items that are dangerous.
· Poisons and toxins are locked.
· All floors shall be clean and safe.
· Bathrooms were observed to be safe, sanitary and in operating condition.
· Playgrounds are enclosed by appropriate fences and free of hazards.
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin.
· Food is stored appropriately and protected from contamination.
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.
· Menus shall be posted at least one week in advance in a place visible by the child’s authorized. representative, dated and kept on file for 30 days, and made available upon request.
· Uncontaminated drinking water shall be readily available both indoors and outdoors and provided by.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall.
· Sign in/Sign out record was reviewed and meets regulation requirements.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 03/14/2025
· Opening and closing staff member’s CPR/First Aid expires on 3/2025
· Director completed Health and Safety Training- Fall of 1996
· A review of children’s records was conducted, and records were found to be incomplete during this inspection.
· Disaster drills to be conducted every six months – last drill was conducted on 09/14/2023
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 334801219
VISIT DATE: 10/12/2023
NARRATIVE
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·The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· A review of staff records indicates that all staff present meet minimum qualifications for the position for which they were hired.

· A review of staff records on 10/12/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA discussed AB 2370 and provided a copy of PIN 21-21-CCP which explains the requirement for lead testing of water. All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead. Also, for a license issued on or after July 1, 2022, initial testing results shall be received and posted by January 1, 2023.
For more information visit:
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

- Director Wendy Serna was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 platform. 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.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 334801219
VISIT DATE: 10/12/2023
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- To access on-line Licensing forms & Regulations for a Child Care Center please visit: www.ccld.ca.gov.


- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200


Exit interview conducted and report was reviewed with Director Wendy Serna. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See LIC809-D for cited deficiencies.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/12/2023 06:08 PM - 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 334801219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. S4 is missing proof of MMR immunization in their file at this time.
POC Due Date: 10/26/2023
Plan of Correction
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Director agrees to provide proof of immunity to MMR for S4 to LPA via email by 10/26/2023 by 5:00 PM.
Email: Raymond.Moorehead@dss.ca.gov
Type B
Section Cited
CCR
101221(b)(6)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. C5 is missing an admission agreement in their file at this time.
POC Due Date: 10/26/2023
Plan of Correction
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Director agrees to provide proof of a signed admission agreement for C5 to LPA via email by 10/26/2023 by 5:00 PM.
Email: Raymond.Moorehead@dss.ca.gov
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: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 10/12/2023 06:08 PM - 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 334801219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. C3 is missing a completed health history form in their file.
POC Due Date: 10/26/2023
Plan of Correction
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Director agrees to provide proof of a completed health history form for C3 to LPA via email by 10/26/2023 by 5:00 PM.
Email: Raymond.Moorehead@dss.ca.gov
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.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6