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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401074
Report Date: 03/20/2023
Date Signed: 03/20/2023 01:31:57 PM

Document Has Been Signed on 03/20/2023 01:31 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:JEANA COURSONFACILITY TYPE:
850
ADDRESS:1709 E. PALMDALE BLVD.TELEPHONE:
(661) 272-3708
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: DATE:
03/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Jean CoursonTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Carol Heath met with La Petite Academy Director, Jean Courson, for a Case Management Incident inspection involving an Incident Report dated 2/7/23. The incident occurred on 02/1/23.

Description of the incident: A child had a tantrum and fell into a chair hitting her right eye by herself. No day children are involved. The child was upset because she was unable to get some cookies from the classroom aide.

Based on the interview conducted and the video observed, the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore, no deficiencies were cited.

An exit interview was conducted, a copy of this report was read and provided to the director, Jean Courson.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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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