490109441-6-3-2022-01-CC-ASTR-CF32Q3-20220603173516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490109441
Report Date: 06/03/2022
Date Signed: 06/03/2022 05:35:31 PM

Document Has Been Signed on 06/03/2022 05:35 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	LA PETITE ACADEMY-INFANT		FACILITY NUMBER:	490109441
ADMINISTRATOR:	SARAH KALUA		FACILITY TYPE:	830
ADDRESS:	2055 OCCIDENTAL ROAD		TELEPHONE:	(707) 573-1623
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY:	22	CENSUS: 11	DATE:	06/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Lisa Gray		TIME COMPLETED:	05:50 PM

NARRATIVE

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A required one year inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with acting Director, Assistant Director, Lisa Gray (D1). The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. Facility representative, Lisa Gray was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This program is an infant center serving children up to 2 years of age and part of a combination center with a preschool and school-age license. Children of different age groups have separate activity areas. Operating hours are 07:00am-06:00pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan were verified. The facility was clean and orderly. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of reach of the children. D1 stated there are no poisons stored on the premises and none were observed. The toys, floors and other equipment are clean, safe and age appropriate for infants. There was a crib available for each infant still napping in a crib or a cot for infants no longer using cribs. The changing table is sanitary and within arm's reach of a sink. A current menu was posted. Food prep areas are clean. Food is properly stored and refrigerated as needed. Garbage cans containing solid waste have tight fitting lids. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. The playground is completely fenced. There were no bodies of water observed. D1 stated no firearms are stored on site and none were observed. During today's inspection, staffing ratios were being met, 11 infants were being supervised by 4 staff, operating within the licensed capacity and ratio requirements. At least one staff member, Staff 4 (S4) present during the inspection possessed current CPR and First Aid certifications, which expire 07/2023. Sign in/out procedure was reviewed and in compliance.

Continued on LIC 809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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 06/03/2022 05:35 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LA PETITE ACADEMY-INFANT	FACILITY NUMBER: 490109441
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 4 staff files, Staff 1 & Staff 3 (S1 & S3) did not have proof of immunity to influenza, pertussis and measles on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	D1 stated that she will speak to S1 and S3 and have them provide proof of immunity to pertussis, measles, and influenza or a statement declining the influenza vaccine. D1 will send proof to LPA Strother by email at amy.strother@dss.ca.gov

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 4 staff files. Staff 1 (S1), Staff 2 (S2) and Staff 4 (S4) files either did not contain a Mandated Reporter Training certificate or it was not current which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	D1 will require S1, S2 and S4 to complete the Child Care Provider Mandated Reporter Training at mandatedreporterca.com and provide a copy of the current certificate to LPA Strother by 06/24/2022 by email, amy.strother@dss.ca.gov

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LA PETITE ACADEMY-INFANT	FACILITY NUMBER: 490109441
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101215.1(m)

Child Care Center Director Qualifications and Duties

(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above. LPA did not have verification of any one staff on site holding a Preventative Health & Safety training certificate, when LPA asked D1 if a staff on site had the training, D1 was unable to provide a certificate and stated that she wasn't sure that anyone had taken the training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	D1 stated that she may have completed the training in the past and if so will locate her certificate or will look into completing the training as required. D1 will submit certificate of training completion to LPA Strother by 06/24/22 or arrange for a due date based on class availablilty.

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 5 out of 10 files. Child 4 (C4), C6, C7, C8 and C11 did not have current immunization records on file for their ages as required which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	D1 will request updated immunization records for the parents or authorized representative for children C4, C6, C7, C8 and C11, update the blue card (PM286 or CDPH286) on file. D1 will submit updated blue cards to LPA Strother by 06/24/22 by email at amy.strother@dss.ca.gov

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/03/2022 05:35 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LA PETITE ACADEMY-INFANT	FACILITY NUMBER: 490109441
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.3(a)

Modifications to Infant Needs and Services Plan

(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 10 out of 11 infant needs and service plans reviewed. Child 2 - Child 11's (C2-C11) infant needs and service plans had not been updated quarterly, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	D1 stated that she will have the parent or authorized representative of children C2-C11 update their infants needs and services plans to assure its accuracy. Moving foward to stay in compliance with the requirement, D1 stated she will keep a calendar of when updates need to be completed for each infant in care. D1 will send a copy of the calendar showing date(s) updates are due for all 15 children enrolled as well as the updated plans to amy.strother@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LA PETITE ACADEMY-INFANT	FACILITY NUMBER: 490109441
	VISIT DATE: 06/03/2022

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Four staff files were reviewed. 2 out of 4 staff files did not contain documentation of immunization's as required. Three out of the 4 staff files reviewed did not contain documentation of current Mandated Reporter Certificates as required. A review of staff files indicated that no staff on site has completed the Preventative Health & Safety training course as required. During an interview, D1 stated that she was unaware of any staff having a Preventative Health & Safety certificate on file. Ten children's records were reviewed. A review of records indicates that 5 out of the 10 records did not contain updated immunization records as required based on the age of each child. A review of 11 Infant Needs and Services Plans for children under 2 years of age indicated that 10 out of the 11 were not reviewed by a parent or authorized representative quarterly as required.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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: http://www.ada.gov/childqanda.htm

All licensing reports are public information and must be made available upon request for at least three years.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Lisa Gray.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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