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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566200350
Report Date: 04/20/2022
Date Signed: 04/21/2022 10:07:35 AM


Document Has Been Signed on 04/21/2022 10:07 AM - 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:141CENSUS: 10DATE:
04/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:36 AM
MET WITH:Katherine Stevens & Shannon SuttonTIME COMPLETED:
10:25 AM
NARRATIVE
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On April 21, 2022 at 7:41 AM, Licensing Program Analyst (LPA) Dean Thompson conducted an unannounced Case Management inspection. LPA met with District Manager Katherine Stevens & Director Shannon Sutton and advised the purpose of the inspection. LPA was provided a tour of the facility. There were ten children in care at the time of the inspection.

On 4/18/2022, Director Shannon Sutton contacted Community Care Licensing (CCL) to self-report an incident of a parent who witness a Staff (S1) on 4/15/2022 at 3:24 PM, walk over to child (C1) and pick up the side of the cot, causing (C1) to roll off the cot and onto the floor while sleeping. Approximately one minute later, (S1) walked over to child (C2), picking up the cot, causing (C2) to roll off the cot and onto the floor while sleeping.

LPA Thompson reviewed the video provided by District Manager Katherine Stevens. Video evidence shows (S1) waking up to two Pre-School children by picking up the cots from underneath them, while the children were asleep, causing them to roll over onto the floor. LPA observed (C2) to be distraught while sitting on the floor.

Interviews determined, (S1) was placed on administrative leave on 4/15/2022, 20 minutes after (S1) was observed violating children's personal rights by District Manager Katherine Stevens via video. Interviews and documents reviewed by LPA, show (S1) employment was terminated on 4/18/2022.

Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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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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: 04/20/2022
NARRATIVE
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After reviewing the incident on video, LPA determined that the incident was true and did occur. Given the facility's account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed the facility's action was appropriate. The facility acknowledged they are being transparent and ensuring the safety of the children in their care.

LPA requested a copy of the video from District Manager Katherine Stevens. District Manager Katherine Stevens stated she would have to receive a subpoena for a copy of the video.

The following CCR, Title 22, Division 12 regulation was discussed: 101214(a)(1) Accountability

The following CCR, Title 22, Division 12 regulation was cited: 101223(a)(3) Personal Rights.

One type B deficiency was cited during today's inspection and one Technical Advisory.

A notice of site visit was given 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 Director Shannon Sutton.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 04/21/2022 10:07 AM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 566200350

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2022
Section Cited

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation,...or aids to physical functioning.
This requirement is not met as evidence by:
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Teacher was observed pulling mats from underneath Child (C1) and Child (C2) while both children were asleep, causing children to roll off the cot, onto the floor and interupting their sleep. This poses as a potential Health and Safety risk to 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.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
LIC809 (FAS) - (06/04)
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