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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409418
Report Date: 10/01/2024
Date Signed: 10/01/2024 02:13:00 PM

Document Has Been Signed on 10/01/2024 02:13 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: 11DATE:
10/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Maria Goldman, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On Tuesday, October 1, 2024, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced Case Management -deficiencies to follow up in regards the deficiencies given June 18, 2024, during the annual inspection and met with director Maria Goldman.

During this inspection LPA Rivera review files and observed staff #1 MMR, influenza declination and LIC 503 Health Screening Report. Staff #3 influenza declination and staff #4 TB, LIC 503 and 3 units in infant and toddlers. LPA Rivera cleared the deficiencies.

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 and appeal rights were reviewed with director Maria Goldman.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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