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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622572
Report Date: 03/27/2023
Date Signed: 03/27/2023 12:35:28 PM

Document Has Been Signed on 03/27/2023 12:35 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LITTLE STRIVERS ACADEMY INC.FACILITY NUMBER:
393622572
ADMINISTRATOR:GABRIELA AMERICOFACILITY TYPE:
830
ADDRESS:340 MISSION RIDGE DRIVETELEPHONE:
(408) 449-7116
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 7DATE:
03/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Azra ArshadTIME COMPLETED:
12:30 PM
NARRATIVE
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On 03/27/2023 at 10:00 AM, Licensing Program Analysts (LPAs) Tiffanie Diep and Lauren Scott met with DIrector, Azra Arshad, for the purpose of an unannounced case management visit.

LPAs were made aware that Licensee terminated care for a child on 01/18/2023. Licensee disclosed that a written notice was provided to the child’s parent on 01/18/2023. Interviews with Licensee and facility staff revealed that the child cried for extended periods of time while in care and staff were unable to console the child. A review of records determined that the director-parent/guardian contract states a two-week written termination notice must be provided in advance of the ending date by either the parent/guardian or the provider. Reasons for termination by the provider includes inability of the child to adjust to child care and inability of the provider to meet the child’s needs. The contract indicates that termination is a last option when the parents/guardians and provider are unable to resolve the issue collaboratively and these reasons are not listed as cause for immediate termination.

Based on the information obtained during interviews and records reviewed, it is determined that collaborative efforts were not made to address the ongoing behavioral concern with the child’s parent and a two-week written notice was not provided by the licensee prior to the termination date. LPAs informed Licensee that they are required to comply with all terms and conditions described in the admission agreement per Title 22 Regulations. A deficiency is being cited on the attached LIC 809-D.

An exit interview was conducted and report was reviewed with the director, Azra Arshad. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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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Document Has Been Signed on 03/27/2023 12:35 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 03/27/2023 at 10:52 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: LITTLE STRIVERS ACADEMY INC.
FACILITY NUMBER: 393622572

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/27/2023
Section Cited
CCR
101219(f)

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101219 Admission Agreements (f) The licensee shall comply with all terms and conditions set forth in the admission agreement. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not ensure compliance with the terms and conditions
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Director stated they will develop a written addendum to obtain written documentation outlining the facility’s termination policies and will provide an updated director-parent/guardian contract to LPA by 04/27/2023
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described in the admission agreement as they did not address a child’s ongoing behavioral concern in collaboration with the parent and did not provide a two-week written termination notice which poses a potential health, safety, or personal rights risk to children in care
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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:Chayntel Hunter
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023


LIC809 (FAS) - (06/04)
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