566213952-4-27-2023-17-CC-GRES-CRASGN-20230427135215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566213952
Report Date: 04/27/2023
Date Signed: 04/27/2023 01:52:26 PM

Document Has Been Signed on 04/27/2023 01:52 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 ACADEMY		FACILITY NUMBER:	566213952
ADMINISTRATOR:	SHANNON SUTTON		FACILITY TYPE:	830
ADDRESS:	85 BONITA DRIVE		TELEPHONE:	(805) 526-7846
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	24	CENSUS: 18	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Shannon Sutton		TIME COMPLETED:	02:05 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 April 27, 2023 at 10:00 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced 1 Year Required inspection at the child care center (CCC) located at the above address. The purpose of the inspection was discussed with Director Shannon Sutton, who provided a tour of the facility. The center operates from 6:30 AM to 6:30 PM, Monday to Friday. LPA asked pre screening questions related to COVID-19 and director's responses indicate there are no COVID-19 exposure on site. There were 15 infants in the play yard supervised by 4 staff and 3 infants in the classroom supervised by one staff. LPA observed that licensing-required notices are posted prominently at the entrance door. The CCC is a combination of Preschool and Infant. There are two classrooms in use for infant care. Age-appropriate activities, and furniture were available for children in both classrooms, and the outdoor playground had age-appropriate toys and equipment. . Each classroom had a changing table with sink readily accessible. LPA observed eight cribs available for infants to use. Facility uses cots for older infants that do not use the cribs. Food and milk is stored in a refrigerator located in the classroom. . Children bottles and food were properly labeled with child's name and date. LPA did not observe any toxins/hazardous items accessible to children. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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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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: 566213952
	VISIT DATE: 04/27/2023

NARRATIVE

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A sampling of children and staff records were reviewed. LPA reviewed a sampling of Individual needs & services plans and feeding plans It was noted that 3 infants do have LIC 9227 or Individual Safe Sleep Plan on file. On the other hand, teachers check and document napping infants every 15 minutes. Teachers present have current Pediatric First Aid/CPR certificate that expires on 6/15/2023. Director was advised to obtain Pediatric CPR training from EMS affiliated agency. All staff have renewed the Mandated Reporter Training. All staff have Health Screening record on file including the tuberculosis clearance. LPA verified SB 792 Child Care Adult Immunization.

During today's inspection, deficiency was cited and Technical Assistance were issued. Appeal Rights were given and issued.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Continued on LIC 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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: 566213952
	VISIT DATE: 04/27/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 year old and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Report was reviewed, exit interview was conducted with Director, Ms. Shannon Sutton.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2023 01:52 PM - 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: 566213952
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.2(b)(2)

Infant Needs and Services Plan

(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above, Infant 1, 2 and 3 do not have LIC 9227 on filewhich poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Director agreed to submit a written plan of correction (POC) on how to ensure that parents of infant 0-12 months have completed the LIC 9227, Infant Safe Sleep Plan. POC shall be submitted no later than 5/1/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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