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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801080
Report Date: 03/17/2022
Date Signed: 03/17/2022 12:53:35 PM


Document Has Been Signed on 03/17/2022 12:53 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
364801080
ADMINISTRATOR:ARACELI QUACHFACILITY TYPE:
850
ADDRESS:620 BASELINETELEPHONE:
(909) 874-5113
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:68CENSUS: 56DATE:
03/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Director Arceli Quach TIME COMPLETED:
01:00 PM
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Licensing Program Analyst's (LPA's) Diana Brasel and Patricia Berry arrived at the facility for the purpose of interviewing a child in reference to a complaint with a different school. LPA 's met with the Director and disclosed the purpose of the visit. During the visit observations were done along with interviews. Documents were gathered as well.

An exit interview was conducted with the director, Arceli Quach. Appeal rights were given, a copy of the report, and the Notice Of Site Visit. The Notice of Site visit shall be posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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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