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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210591
Report Date: 12/18/2019
Date Signed: 12/18/2019 10:46:30 AM

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:
566210591
ADMINISTRATOR:CHRISTINA HERNANDEZFACILITY TYPE:
850
ADDRESS:261 WEST STANLEYTELEPHONE:
(805) 652-0917
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:60CENSUS: 49DATE:
12/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Rosa BeltranTIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jill Laxo and Christian Patterson conducted an unannounced Case Management inspection. LPAs met with director Rosa Beltran and discussed the purpose of the inspection. LPAs inspected the area where the incident occurred; interviewed director and T#1; and reviewed child record. There were 49 children supervised by 8 teachers in care at the time of the inspection.

On 11/13/2019, facility director Rosa Beltran contacted Community Care Licensing (CCL) to self report an incident. At approximately 4:30 on 11/12/2019, Teacher #1 was about to leave for the day when they noticed C#1 standing on a sensory table crying alone in a classroom. The classroom teacher T#2 was outside with 11 children. Teacher #1 escorted C#1 outside and informed T#2 of the situation. T#2 stated the class had been outside for approximately two minutes. Per director Beltran the paperwork for transitioning shows that the child may have been alone in the classroom for five minutes.

Pursuant to Title 22 of the California Code of Regulations, the following Type A deficiency was cited (refer to LIC 809-D). Licensee shall post these reports for 30 days and provide copies of these licensing reports to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The Licensee has been provided a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site Visit) was posted.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
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: 566210591
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2019
Section Cited

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101229(a)(1) Responsibility for Providing Care and Supervision. ... No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Based on record review and interviews the
licensee failed to provide supervision to children in care, which poses an immediate Health, Safety or Personal Rights 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.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2019
LIC809 (FAS) - (06/04)
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