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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401088
Report Date: 04/10/2024
Date Signed: 04/10/2024 03:30:53 PM

Document Has Been Signed on 04/10/2024 03:30 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LA PETITE ACADEMY INC.FACILITY NUMBER:
197401088
ADMINISTRATOR/
DIRECTOR:		ASHLEY PEREZFACILITY TYPE:
840
ADDRESS:28041 SECO CANYONTELEPHONE:
(661) 297-0977
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 18DATE:
04/10/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:33 PM
MET WITH:Maria Goldman, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On Wednesday, April 10, 2024 Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced case management deficiencies that was given on 1/11/2024 for having the incorrect Pediatric First Aid/CPR certification and met with Director Maria Goldman. LPA entered school-age classroom and observed 18 school age children with two staff providing care and supervision. LPA observed director Maria Goldman's and two staff Pediatric First Aid/CPR certificate from the American Heart Association Pediatric First Aid/CPR dated 3/30/24. LPA Rivera cleared the Type B citation.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, during which this report and the Appeal Rights were discussed with Director Maria Goldman.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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