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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801080
Report Date: 06/06/2022
Date Signed: 06/06/2022 04:42:36 PM


Document Has Been Signed on 06/06/2022 04:42 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: 38DATE:
06/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 AM
MET WITH:Wendy Ohneck/assistant directorTIME COMPLETED:
05:05 PM
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On 6/6/22 at 4:00 pm, Licensing Program Analysts (LPAs) Patricia Berry and Diana Brasel conducted a subsequent complaint investigation. LPAs were granted access into the facility and met with assistant director. LPAs toured facility and took a census.

During a complaint investigation, while conducting staff interviews, it was revealed staff are signing a child in/out of the facility; and not the person who was bringing and removing the child from the facility.


A technical violation has been provided to the staff. Staff will send a written statement of understanding and compliance to the regulation and send the written statement to CCL by 6/10/22.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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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