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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109441
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:02:35 PM

Document Has Been Signed on 03/11/2025 04:02 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LA PETITE ACADEMY-INFANTFACILITY NUMBER:
490109441
ADMINISTRATOR/
DIRECTOR:		SARAH MORRISONFACILITY TYPE:
830
ADDRESS:2055 OCCIDENTAL ROADTELEPHONE:
(707) 573-1623
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 22TOTAL ENROLLED CHILDREN: 20CENSUS: 19DATE:
03/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Sarah MorrisonTIME VISIT/
INSPECTION COMPLETED:
04:02 PM
NARRATIVE
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Licensing Program Analyst (LPA) Amy Strother made an unannounced case management visit to the facility after receiving an Unusual Incident Report (UIR) report on 03/03/25, regarding an infant (C1) being given a portion of another infant’s (C2's) bottle by mistake on 03/03/25. Today, LPA met with Facility Representative, Director, Sarah Morrison (D1).

During today’s visit, 19 infants were being supervised by 5 teachers, between the two classrooms, operating within the licensed capacity and ratio requirements. LPA interviewed D1, Staff 1 (S1) and Staff 2 (S2).

Both staff interviewed stated that bottles for C1 and C2 were both labeled with the infants names, as required. The report stated that staff S1 and S2 were providing breaks to infant teachers when the incident occurred. Staff interviewed corroborated that they were relieving teachers for breaks during the incident. S2 stated that she occasionally fills in when needed in the infant room and was moving too quickly and did not double check that the bottle was the correct bottle when she went to feed C1. The report stated that after C1 drank about 1 to 1.5oz of the bottle containing breast milk, mixed with formula, fed to C1 by S1, S2 noticed that C1 was drinking C2's bottle by mistake. S2 stated during the interview that the remaining contents of the bottle were disposed of and C1 and C2 were given fresh bottles. Based on record review and interviews conducted, there is a preponderance of evidence to show that on 03/03/25 C1 was given a bottle containing breast milk mixed with formula, and not C1's own bottle of Enfamil Gentlease formula as noted in C1's Needs and Service/Care Plan.

During today's visit LPA reviewed the "Infant and Toddler Care Plan" for eight infants (C1-C8). Infant needs and services plans shall be updated at least quarterly, or as often as necessary to assure its accuracy. LPA observed that C2's plan had not been updated since 10/01/24 and had breast milk listed as, "...to be fed the following:" and did not mention mixing breast milk with formula. D1 stated that C2's bottle on 03/03/25 was brought it pre-mixed by C2's authorized representative and they were told that it was a combination of breast milk and formula.

Continue on LIC809 - PAGE 2

Megan AvilesTELEPHONE: (530) -89-5033
Amy StrotherTELEPHONE: (707) 588-5077
DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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
Document Has Been Signed on 03/11/2025 04:02 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
SANTA ROSA CC RO, 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: 03/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2025
Section Cited
CCR
101427(c)

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101427 Infant Care Food Service (c)The infant shall be fed in accordance with the individual plan.


This requirement was not met as evidenced by:
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D1 stated that the staff have been spoked to about slowing down and making sure that they are doing a face to name check and ensuring that the bottle is being given to the correct infant.

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Based on record review and interview, on 03/03/25 C1 was fed another infant's (C2's) bottle by mistake, which poses a potential personal rights or health & safety risk to the children in care.
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Director stated she will submit a written statement acknowledging that the staff have been trained on infant feeding, signed by staff and a written statement on training future staff to ensure infants are given correct bottles.
Type B
03/25/2025
Section Cited
CCR101419.3(a)

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101419.3 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.

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Director stated that she will ensure that C2's parent updates the Needs and Service plan with staff and will submit a written procedure to ensure that all infants Needs and Service Plans are updated every three months.
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Based on record review C2's Needs and Service plan was last updated on 10/01/24 and did not include information about C2's bottle containing both breast milk and formula, only breast milk, which poses a potential personal rights or health & safety risk to the 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.
Megan AvilesTELEPHONE: (530) -89-5033
Amy StrotherTELEPHONE: (707) 588-5077

DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2025

LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LA PETITE ACADEMY-INFANT
FACILITY NUMBER: 490109441
VISIT DATE: 03/11/2025
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PAGE 2

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

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with facility representative, Sarah Morrison.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) -89-5033
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3