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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566200350
Report Date: 09/15/2023
Date Signed: 09/15/2023 12:15:50 PM

Document Has Been Signed on 09/15/2023 12:15 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
566200350
ADMINISTRATOR:SHANNON SUTTONFACILITY TYPE:
850
ADDRESS:85 E. BONITA DR.TELEPHONE:
(805) 526-7846
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 141TOTAL ENROLLED CHILDREN: 141CENSUS: 36DATE:
09/15/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jordan Flores and Shannon SutterTIME COMPLETED:
12:30 PM
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An unannounced Legal Case Management inspection was conducted on 9/15/2023 by Licensing Program Manager George Mingle and Licensing Program Analyst (LPA) Susana Martinez to provide the following letters regarding Tera Cardenas:

ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY

ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES:

LPM Mingle advised Director Shannon and assistant director Jordan Flores that Tera Cardenas is excluded from LA Petite Academy facility number 566200350 and any other licensed facilities by Department of Social Services. Appeal process and instructions have been provided.

The Confirmation of Removal licensing form LIC300E was provided during this inspection and shall be returned to the Regional Office no later than 9/18/2023.

Exit Interview conducted with Director. Notice of Site Visit (LIC 9213) posted and – must remain posted for 30 consecutive days. Failure to maintain posting as required will result in a civil penalty of $100.00. A copy of Appeal Rights (LIC 9058 FAS 01/16) provided.

No deficiencies issued during today's inspection.

George Mingle
Susana Martinez
DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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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