<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600090
Report Date: 08/10/2021
Date Signed: 08/11/2021 07:57:03 AM

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: DATE:
08/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Kristen CobbTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/10/2021 at 2:45 PM Licensing Program Analyst (LPA) Dana Stevens conducted a case management inspection to follow up on an Unusual Incident. LPA met with Director Kristen Cobb and informed Director of the meeting’s purpose. There were 60 pre-schoolers supervised by 9 teachers. There were 14 school aged children supervised by 3 teachers. The facility is within Ratio/Capacity limitations.

On 06/30/2021 at 3:30 PM Child 1 was playing on pre-school play structure when he fell from the swinging bar. Staff 1 was present supervising 12 children and was in ratio. Staff 1 was alerted to the incident by the other children and went directly to Child 1. Child 1 was on the ground below the play structure and was bleeding from the lower lip. Parent of Child 1 was immediately notified and Child 1 was taken to urgent care where the injury was treated with antibiotic ointment. Director reported the incident timely to Licensing department and the completed LIC 624 was received on 07/06/2021.

LPA interviewed Director and Staff 1, who was present at the time of the incident. LPA reviewed the file of the child involved and inspected pre-school playground area and play structure.

Based on inspection, staff interviews and file review incident was an accident. Facility staff notified parents and Licensing department timely and took appropriate measures to provide immediate care for the child.

No Deficiencies cited.

An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit were provided to Director. The Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days.

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021
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 1