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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600088
Report Date: 07/02/2019
Date Signed: 07/02/2019 09:56:57 AM

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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMY INCORPORATEDFACILITY NUMBER:
376600088
ADMINISTRATOR:SUSANNA RODRIGUEZFACILITY TYPE:
850
ADDRESS:4179 AVENIDA DE LA PLATATELEPHONE:
(760) 941-5406
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:112CENSUS: 51DATE:
07/02/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Susanna RodriquezTIME COMPLETED:
10:00 AM
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Licensing Program Analyst, Marlene Wong, conducted a case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 05/10/19. It indicates Child #1 was walking to Child #2 who was cutting his paper with school scissors. Child #1 was cut between the thumb and forefinger on her right hand.

Facility records were reviewed and staff was interviewed. Based on information gathered, Analyst has deemed this incident as an accident and the facility acted appropriately and no violations have been identified. The UIR was sent to CCLD in a timely manner.

The scissors were immediately replaced with plastic scissors. Child #1 is still attending the day care center.

An exit interview was conducted with Ms. Rodriguez and a copy of this report was left at the facility.

Notice of Site Visit was issued and Analyst observed Ms. Rodriguez post the notice.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Marlene WongTELEPHONE: (951) 248-0229
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
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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