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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600090
Report Date: 11/02/2023
Date Signed: 11/02/2023 04:59:08 PM


Document Has Been Signed on 11/02/2023 04:59 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:LA PETITE ACADEMY, INC.FACILITY NUMBER:
376600090
ADMINISTRATOR:KRISTEN COBBFACILITY TYPE:
850
ADDRESS:795 CORRAL CANYON ROADTELEPHONE:
(619) 421-5238
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY:110CENSUS: 57DATE:
11/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Sylvia CardenasTIME COMPLETED:
05:00 PM
NARRATIVE
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On 11/02/2023 LPA Dana Stevens conducted an Unannounced Case Management visit for the purpose of follow up on an Unusual Incident that occurred on 07/19/2023.

During incident follow-up, LPA interviewed Director, staff, children, and daycare parents, reviewed facility records and inspected and photographed preschool playground and play equipment.

Information obtained during interviews and record review confirmed an unusual incident occurred on Wednesday, 07/19/2023 around 4:45 PM, when Child 1 (C1), while riding a tricycle on the preschool playground, rode down a slope and ran into a shade canopy pole, hitting their head on the pole. Though staff did not observe any obvious injuries to C1 at the time of the incident, C1 subsequently developed swelling and discoloration under both eyes over the following two days and was taken by parent for medical assessment on 07/21/2023. The Director was informed of the medical assessment the following week by C1's parent and Director reported the Unusual Incident timely to Licensing Department on 07/25/2023.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LA PETITE ACADEMY, INC.
FACILITY NUMBER: 376600090
VISIT DATE: 11/02/2023
NARRATIVE
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During inspection of the playground LPA observed the position of the shade canopy in relation to the slope in the surface of the playground posed a potential hazard to children riding tricycles. Based on information obtained in interviews and record review, the sloped surface facilitated C1 riding her tricycle into the shade canopy pole which resulted in an injury to C1 that required medical treatment.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Exit interview conducted and report was reviewed with the Assistant Director, Sylvia Cardenas. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/02/2023 04:59 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: LA PETITE ACADEMY, INC.
FACILITY NUMBER: 376600090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2023
Section Cited
CCR
101238.2(d)(1)

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101238.2 Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained:
1) In a safe condition for the activities planned...this requirement was not met as evidenced by,

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DIrector removed tricycles from playground pending the installation of padding on the metal poles of the shade canopy.
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Based on observation, interview, and record review, facility did not ensure a safe enviroment for the activities planned by allowing children to ride tricycles on the preschool playground near a surface that sloped downward towards a metel shade canopy, which posed a potential health and safety risk to children in care riding tricycles.
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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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3