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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210591
Report Date: 10/19/2022
Date Signed: 10/19/2022 02:33:22 PM


Document Has Been Signed on 10/19/2022 02:33 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:
566210591
ADMINISTRATOR:REBECCA DELGADOFACILITY TYPE:
850
ADDRESS:261 WEST STANLEYTELEPHONE:
(805) 652-0917
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:60CENSUS: 30DATE:
10/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:Rebecca HernandezTIME COMPLETED:
01:13 PM
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On October 19, 2022 at 11:47 AM , Licensing Program Analyst (LPA) ) Rona Chavez conducted an unannounced Case Management inspection. LPA met with facility Director Rebecca Hernandez and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 30 children in care and 5 staff at the time of the inspection.

On 10/18/2022 facility self reported that on 10/13/2022 at transition to outside play at 4pm Child 1 (C1) was left unattended for a few minutes. S1 reported that during transition to outside she counted all the kids and checked them off on the face to name sheet. She did not know the child returned into the classroom, and it could have been when she was updating the teacher outside on the class. When S1 spoke with C1, C1 stated she was behind the cabinet hiding. S2 was in the class room that shares a 1/2 door and jack and jill restroom and heard child playing in the class and took her outside. S2 will provide a retraining to staff and observe transition to come up with a plan to ensure that the situation will not occur again.

Today, LPA inspected the class room and observed where the incident took place as well as interview staff. The Director reported the incident and submitted the incident report to the Department as required.

Given the information obtained, Facility is being given a technical assistance for Care and Supervision due to the child being left in the unattended.
California Code of regulation, Title 22, Division 12 regulation 101229(a)(1) Responsibility for Providing Care and Supervision

Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 Civil Penalty.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona ChavezTELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022
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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