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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409418
Report Date: 06/18/2024
Date Signed: 06/18/2024 04:46:04 PM

Document Has Been Signed on 06/18/2024 04:46 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 ACADEMYFACILITY NUMBER:
197409418
ADMINISTRATOR/
DIRECTOR:		ASHLEY PEREZFACILITY TYPE:
830
ADDRESS:28041 SECO CANYON ROADTELEPHONE:
(661) 297-0977
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 12DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Patty BentacourtTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On Tuesday, June 18, 2024, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with assistant director Patrica Betancourt who guided LPA Rivera on a tour of the facility.

This is an infant program that serves children ages 0 to 2 years. This program operates Monday to Friday 6:30 a.m. – 6:00 p.m. Sign in and out takes place at the main entrance area. Teacher and child ratio were observed, and present staff are fingerprinted cleared and at least one person present who is trained in pediatric first aid/CPR is present (listed on LIC 859). Annual fee is current.



At approximately 10:25 am. LPA entered the toddler classroom. LPA Rivera observed 8 toddlers with staff #1 and #2 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored on top of the kitchenette countertop making it inaccessible for children to reach. LPA Rivera observed two step trash bins with a lid for diapers and one for trash. LPA observed the diapering changing table to be arm’s length to the handwashing sink and a vinyl diapering mat. Per assistant director Patrica, soiled clothing is not rinsed in the sink. It is placed in a plastic bag and sent home and the vinyl mat is cleaned and disinfected with soap, water, and bleach/water mixture. LPA observed children’s personal items to be in individual bins.

At approximately 10:36 am. LPA entered the infant classroom. LPA Rivera observed 4 infants with staff #5. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored on top of the kitchenette countertop making it inaccessible for children to reach. LPA did not observe infants napping. LPA observed the emergency cribs to be free from bumper pads, pillows, toys, blankets, hanging above items.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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 06/18/2024 04:46 PM - It Cannot Be Edited


Created By: Mayra Rivera On 06/18/2024 at 02:20 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
FACILITY NUMBER: 197409418

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in staff #3, staff #5 and staff #7 not providing proof of MMR, and TDAP and staff 1, 2,3,4,5,6,7 not providing proof of influenza or declination which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2024
Plan of Correction
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Assistant director stated will ask staff to complete influenza declination or submit proof of influenza within the year and those who are missing proof of MMR and TDAP to submit by due date
Type B
Section Cited
CCR
101416.2(c)(1)(A)
Infant Care Teacher Qualifications and Duties
(c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. (A) At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in staff #2, staff #4 and staff #5 in not providing proof of infant/toddler units completion which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2024
Plan of Correction
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LPA Rivera provided an sample of an exception letter for infant/toddler staff enrollment. Assistant director stated, will complete an exeption letter and submit proof of enrollement and syllabus by due date for the staff who are currently enrolled infant/toddler course.
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: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 197409418
VISIT DATE: 06/18/2024
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LPA observed the mat with a fitted sheet. LPA Rivera observed two step trash bins with a lid, one for diapers and one for trash. LPA observed the diapering changing table to be arm’s length to the handwashing sink and a vinyl diapering mat. Per assistant director Patrica, soiled clothing is not rinsed in the sink. It is placed in a plastic bag and sent home and the vinyl mat is cleaned and disinfected with soap, water, and bleach/water mixture. LPA observed children’s personal items to be in individual bins. LPA also observed infant bottles and food to be labeled with names and dated 6/18/2024 inside the fridge in their own individual bins.

Heating, lighting, and ventilation were evaluated by LPA Rivera. LPA observed central AC /heater and vents located on the ceiling. LPA observed the thermostat located in infant and toddler classrooms and the temperature to be at 73. LPA observed the fire extinguishers located in classrooms and hallways and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on 6/28/23 and 6/7/2024. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. The carbon monoxide detector is in the prek classroomy and LPA Rivera tested and heard the sound and is operable. The last emergency drill was conducted on 3/24/2024. Lead testing was conducted on 9/16/2022 and no lead exceedance.

For the toddlers, LPA observed sleeping cots to be in good condition. First aid kits supplies are kept inside the classrooms and LPA observed the kits to be fully equipped with band aids, gauzes, adhesive bandages, and antiseptic wipes. During this visit, assistant director Patrcia stated currently has no children with medication or severe food allergies. LPA Rivera asked if there were any poisons, firearms, weapons, or bodies of water. The director stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Director stated the ill isolation area takes place in the director’s office and children utilize the staff restroom.

At approximately 10:37 a.m. LPA Rivera entered the outdoor play area. LPA Rivera observed the playground to be fenced all around and the gate that leads to the parking lot, closed, and locked with a keypad lock. LPA Rivera observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA Rivera observed play structure equipment to be age appropriate and areas around or under climbing equipment, are cushioned with artificial turf and granulated rubber mat underneath that may absorb a fall and. For adequate shade, LPA Rivera observed 1 hip roof shade structure. For outdoor water drinking, staff bring out water

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 197409418
VISIT DATE: 06/18/2024
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pitchers and children sippy cups.

This program provides meals and snack for the toddlers and infant parent provide formula and meals. Meals and snacks are prepared onsite. LPA Rivera informed assistant director Patricia that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Rivera observed water pitchers, bottles and sippy cups in the classrooms. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects and rodents.


The following documents were posted in a prominent, publicly area front lobby: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and PUB 269 Child Passenger System Poster, and Daily Schedule.

LPA Rivera reviewed the children’s roster, children’s files, staff files, 15-minute sleep logs, and sign in/out sheets and observed 12 signed in signatures.

LPA Rivera did not observe assistant director immunizations, Pediatric First Aid/CPR certification or Preventative Health and Safety with nutrition and lead component. LPA informed assistant director the immunization requirements Assistant director has completed the mandated reporter (AB 1207) training dated 9/28/2022. Assistant Director was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com


The following was also discussed with director:
1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 197409418
VISIT DATE: 06/18/2024
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3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

4.LIC 125 Entrance Checklist provided, and LPA informed that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review.

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10. Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, AB 1207 Mandated Child Abuse Certification, MMR, TDAP, TB, influenza, or influenza declination.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 197409418
VISIT DATE: 06/18/2024
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Assistant director Patricia Betancourt was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.



For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA Rivera discussed the safe sleep regulations with assistant director Patricia Betancourt and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Patricia Betancourt of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 197409418
VISIT DATE: 06/18/2024
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Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assistant director Patricia Betancourt was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.


The deficiencies listed on the following page was observed by LPA Rivera and is being cited in accordance with California Code of Regulations Title 22 or Health and Safety code. Two type B deficiencies are being issued today for regulations 1596.7995(a)(1)- (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year and 101416.2(c)(1)(A)- (c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. (A) At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants Please see attached LIC 809-D for citation.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with assistant director Patricia Betancourt.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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