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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109141
Report Date: 07/24/2019
Date Signed: 07/24/2019 03:32:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LA PETITE ACADEMY - PRESCHOOL/SANTA ROSAFACILITY NUMBER:
490109141
ADMINISTRATOR:STEVENS, KATHERINEFACILITY TYPE:
850
ADDRESS:2055 OCCIDENTAL RDTELEPHONE:
(707) 573-1623
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:85CENSUS: 50DATE:
07/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Katherine StevensTIME COMPLETED:
03:45 PM
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An annual random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility’s operating hours are 6:30 a.m. - 6:00 p.m., Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The director stated that there are no poisons stored on the premises and none were observed during today's inspection. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors, indoors with individual water bottles and with a drinking fountain outside . The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. The Director stated that the wood chips are replenished once a year, during the month of August. There were no bodies of water observed. The director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and a total of 50 children in three different classrooms were being supervised by 7 teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Ten children’s records were reviewed at 11:19 a.m., and contained signed admission agreements. Two staff records were reviewed at 12:05 p.m. and contained documentation of education and training as required.
Continue on LIC809-C
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LA PETITE ACADEMY - PRESCHOOL/SANTA ROSA
FACILITY NUMBER: 490109141
VISIT DATE: 07/24/2019
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This facility is not currently providing Incidental Medical Services (IMS), the director stated that there are no children currently enrolled that require IMS. The Department’s IMS policy was discussed with the Director. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices, The Effects of Lead Exposure brochure, and the Community Care Licensing website were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
LIC809 (FAS) - (06/04)
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