<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401074
Report Date: 01/15/2025
Date Signed: 01/15/2025 12:56:47 PM

Document Has Been Signed on 01/15/2025 12:56 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LA PETITE ACADEMY INC.FACILITY NUMBER:
197401074
ADMINISTRATOR/
DIRECTOR:		JEANA COURSONFACILITY TYPE:
850
ADDRESS:1709 E. PALMDALE BLVD.TELEPHONE:
(661) 272-3708
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 70DATE:
01/15/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:53 AM
MET WITH:Gina Quessenberry, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
01:10 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 01/15/2025, Licensing Program Analyst (LPA) Justeene Tamayo met with Assistant Director, Gina Quessenberry, who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for a UIR received at Palmdale RO on 01/03/2025. LPA disclosed the purpose of the inspection to the facility representative. When LPA arrived at the facility there were 70 preschool age children in care, with 9 teachers.

Description of Incident: On 01/03/2025, Child #1 was playing on the slide structure, and was facing the incorrect way. According to the facility, child #1 slid down on their tummy and child #1 sustained a cut on their chin while going down the slide. A cold towel was applied by Assistant Director, and parents were notified. Per Assistant Director, Teacher #1 who witnessed the incident has been transferred to another location and no longer works at this facility.

During this inspection, LPA Tamayo interviewed children #1-3, and staff involved. The interviews revealed that Teacher #1 did provide care and supervision to child #1, however Teacher #1 did not intervene while child #1 went down the slide the incorrect way, resulting in child #1 sustaining an injury to their chin. Child #1 was taken to the emergency room by parent #1, and adhesive glue was applied to the injury.

As a result of this information, the facility has been issued a Type B Citation Personal Rights. Please refer to the LIC809-D for the details of this deficiency.



An exit interview was conducted, and a copy of this report was read and provided to the Assistant Director, along with a copy of her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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
Document Has Been Signed on 01/15/2025 12:56 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 01/15/2025 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 197401074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2025
Section Cited
CCR
101223(a)(2)

1
2
3
4
5
6
7
Personal Rights 101223(a)(2): The licensee shall ensure that each child is accorded the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidence by:
1
2
3
4
5
6
7
Assistant Director will conduct a training with staff to ensure play equipment is used the appropriate way to ensure no incidents will reoccur. Assistant Director will send sign in sheets of the agenda to LPA Tamayo no later than 02/05/2025.
8
9
10
11
12
13
14
On 01/03/25, child #1 went down the slide the incorrect way and hit their chin. As a result, child #1 was rushed to the emergency room, where adhesive glue was applied to the injury, which poses a potential risk to day care children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2