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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401087
Report Date: 01/11/2023
Date Signed: 01/11/2023 02:06:15 PM

Document Has Been Signed on 01/11/2023 02:06 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LA PETITE ACADEMY INC.FACILITY NUMBER:
197401087
ADMINISTRATOR:ASHLEY PEREZFACILITY TYPE:
850
ADDRESS:28041 SECO CANYONTELEPHONE:
(661) 297-0977
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 93TOTAL ENROLLED CHILDREN: 93CENSUS: 51DATE:
01/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director Maria Rivera GoldmanTIME COMPLETED:
02:30 PM
NARRATIVE
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On 01/11/23, Licensing Program Analysts (LPAs) Joselito L. Del Mundo and Carol Heath conducted an unannounced complaint investigation on La Petite Academy Inc. in Saugus California. Upon arrival, LPAs met with the Director Maria Rivera Goldman for a Case Management – Deficiencies inspection involving a complaint dated 01/09/23. Upon arrival, there were 51 children.

Description of the situation:

On 01/11/23, during the 10 day visit complaint, Licensing Program Analysts (LPAs) Joselito L. Del Mundo and Carol Heath toured the facility and observed that cleaning supplies are in an unsecured (unlock) cabinets in pre-kindergarten and pre-school class rooms. Also, LPAs reviewed three staff files. Based on Guardian website, Vanessa Rodriguez fingerprint records is still in process and Kaitlyn Witt is not associated with the facility.

Based on observations and records review, the preponderance of evidence has been met, therefore the allegation is Substantiated.

Deficiency cited. Type “A” California Code of Regulations, Title 22 Division 12 Chapter 1 Article 3.

An exit interview is conducted and a copy of this report, a notice of site inspection, and appeal rights were discussed with Director Maria Rivera Goldman.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2023
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 01/11/2023 02:06 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 01/11/2023 at 12:48 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: 197401087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/11/2023
Section Cited
CCR
101170(c)(d)

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Criminal Record Clearance 101170(2)(c)(d) Section 1596.871(b) of Health and Safety Code provides in part: (c) Any person who provides care and supervision to children, (d) Any staff person, volunteer or employee who has contact with the children. This requirement is not met as evidenced by:
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The Director will send the staff home. The Director will have the Guardian account for staff to ensure all staff are fingerprint clear,
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Based on observation and records review, the Director did not ensure a criminal record clearance for her staff which poses an immediate Health, Safety or Personal Rights risk to persons in care,
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Type A
01/11/2023
Section Cited
CCR101238(g)

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Buildings and Grounds 101238(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to chldren shall be stored where inacessible to children. This requirement is not met as evidenced by:
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The Assistant Directror put a lock and secured the cabinet. The Director will have a staff meeting and ensure that staffs follow Title 22 regulations, The Director will email the attendance sheet of the meeting.
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Based on observation, LPAs observed cleaning supplies are not stored in secured cabinets which poses an immediate Health, Safety or Personal Rights risk to persons in care,
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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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023


LIC809 (FAS) - (06/04)
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