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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401088
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:37:02 PM

Document Has Been Signed on 01/11/2024 03:37 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:ASHLEY PEREZFACILITY TYPE:
840
ADDRESS:28041 SECO CANYONTELEPHONE:
(661) 297-0977
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 19DATE:
01/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:02 PM
MET WITH:Maria Goldman, DirectorTIME COMPLETED:
03:55 PM
NARRATIVE
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On Thursday, January 11, 2024 Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced case management inspection and met with Director Maria Goldman. During this visit, LPA Rivera reviewed staff files and observed director and staff to have the incorrect Pediatric First Aid/CPR certification. LPA observed First Aid/CPR, and non EMSA approved certifications.

LPA Rivera explained the required Pediatric First Aid/CPR training and the citation with director Maria and director provided the plan of correction. The due date for correction is February 11, 2024.

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: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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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Document Has Been Signed on 01/11/2024 03:37 PM - It Cannot Be Edited


Created By: Mayra Rivera On 01/11/2024 at 03:24 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: 197401088

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2024
Section Cited
CCR
101616.3

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Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be onsite at all times when children are present.
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Director stated going to schedule the correct Pediatric First Aid/CPR training for all staff by due date.
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 the licensee did not comply with the section cited above in not obtaining pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 which poses a potential 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:Mayra Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024


LIC809 (FAS) - (06/04)
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