566200350-2-21-2020-17-CC-FPEA-BM23FX-20200221171330

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566200350
Report Date: 02/21/2020
Date Signed: 02/21/2020 05:13:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	LA PETITE ACADEMY		FACILITY NUMBER:	566200350
ADMINISTRATOR:	MEGAN GALLOWAY		FACILITY TYPE:	850
ADDRESS:	85 E. BONITA DR.		TELEPHONE:	(805) 526-7846
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	141	CENSUS: 30	DATE:	02/21/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Caitlin Murphy		TIME COMPLETED:	05:25 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 February 21,2020 at approximately 3:30 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. LPA met with facility Director Caitlin Murphy and discussed the nature and purpose of the inspection. LPA and Director conducted a tour of the facility inside and out. There was 30 children in care at the time of the inspection. On 2/13/2020, Director contacted Community Care Licensing (CCL) to self report an incident of two children found alone in the playground by a parent. On 2/10/2020 at approximately 5:20 PM, P1 arrived to pick up their child C1 in the classroom. P1 had noticed their child C1 was outside in the toddler playground with C2. When questioning the teacher in the classroom, it was observed that they did not know the children were alone outside in the toddler playground. The children and teachers returned to the classroom from the preschool playground at approximately 5:15 PM. During the transitioning to the classroom, C1 and C2 were able to enter the toddler playground from the preschool playground. Leaving C1 and C2 unsupervised for approximately five minutes. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LA PETITE ACADEMY	FACILITY NUMBER: 566200350
	VISIT DATE: 02/21/2020

NARRATIVE

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On 2/13/2020, P1 approached the facility director and requested the status of the incident. The facility Director had no knowledge of the incident and investigated it. It was determined that the teacher did not inform management about the incident. Director contacted CCL and advised them of the incident. Both teachers assigned to the classroom during the incident have been removed from the facility.

According to the facility staff C1 and C2 have returned back to the facility for care. They have spoken to teachers regarding positioning of staff and accountability of children. The facility plans on making changes to the gates and provide more training to staff.

At approximately 3:47 PM, LPA determined that the facility failed to provide proper supervision for C1 and C2 during the incident. The children were left alone for five minutes. Facility Director understands and has started to take appropriate action to ensure that the incident does not happen again.

A closing interview was conducted with facility Director. Director was provided and advised of their appeal rights. Director was provided a date of when their plan of correction is required.

One type B deficiency was cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LA PETITE ACADEMY	FACILITY NUMBER: 566200350
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2020 Section Cited	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision ...to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher ... visual observation. This requirement is not met evidence by:
	8 9 10 11 12 13 14	Based on LPA's observations, interviews, and records. The facility left two children without supervison for five mintues. This posese as a potential Health and Safety risk to persons in care.	8 9 10 11 12 13 14	A signed roster stating staff have been trained submitted by 03/06/2020 via fax (805) 685-1820 or email to francisco.pedroza@dss.ca.gov
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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: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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