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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215059
Report Date: 06/28/2021
Date Signed: 06/28/2021 02:44:40 PM

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:
566215059
ADMINISTRATOR:REBECCA DELGADOFACILITY TYPE:
840
ADDRESS:261 W. STANLEY AVE.TELEPHONE:
(805) 652-0917
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:14CENSUS: 12DATE:
06/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rebecca DelgadoTIME COMPLETED:
03:10 PM
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On June 26, 2021, at 1:00 p.m. Licensing Program Analyst (LPA) Jill Laxo conducted an unannounced 1 Year Required Inspection. LPA discussed the reason for the inspection and toured the facility with Director Rebecca Delgado. The school age program operates Monday through Friday from 6:30 a.m. until 6:30 p.m. The program utilizes one classroom and an outdoor playground. Two teachers were supervising 12 children at the time of inspection.

School age classroom was adequately equipped with age and size appropriate furniture and equipment was in decent condition. LPA recommended replacing soiled play mat.

Facility provides morning breakfast, hot lunch and afternoon snack. LPA reviewed the weekly posted menu and required Licensing forms. There are no medications administered at this time. Disinfectants and cleaning supplies are inaccessible to children. Drinking water was readily available both indoors and out. Playground was enclosed with equipment in safe condition including cushioning material and was free of hazards. There were no bodies of water. Director stated there are no guns nor ammunition on the premises.

Personnel records were viewed and contained documents for education, AB 1207, health screening, CPR/First Aid expires 06/24/2022, and criminal background clearance. Sign in/out sheets were viewed. Files for three children in the school age program were reviewed and found complete with required licensing forms including authorized representative contact information and Parent Rights.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 566215059
VISIT DATE: 06/28/2021
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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

LPA discussed with Director PIN 20-01 Lead Testing requirements.



LPA discussed COVID 19 guidance and best practices. Director was reminded that it is their responsibility to know the regulations for the facility, which can be accessed at www.ccld.ca.gov.

In areas evaluated, no deficiencies were observed.


LPA witness Director post the Notice of Site visit (LIC 9213)
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
LIC809 (FAS) - (06/04)
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