<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334801218
Report Date: 10/14/2021
Date Signed: 10/14/2021 03:52:31 PM

Document Has Been Signed on 10/14/2021 03:52 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
334801218
ADMINISTRATOR:WENDY SERNAFACILITY TYPE:
850
ADDRESS:11100 COLLETT AVENUETELEPHONE:
(951) 688-1313
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 104TOTAL ENROLLED CHILDREN: 104CENSUS: 55DATE:
10/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Director Wendy Serna TIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/14/2021 at 1:20pm, Licensing Program Analysts (LPAs) Destinee Hogue and Laura Mejorado conducted a case management inspection with Director, Wendy Serna. A case management inspection is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was submitted to the Riverside Regional Office on 10/06/2021 via telephone and a written report was received on 10/12/2021.

During this inspection, LPAs toured the facility inside and outside, took census of preschool children present on this date, interviewed pertinent parties, reviewed records, and discussed the following with Director, Wendy Serna.

At this time, further information will be needed and upon completion of the review, the outcome and/or recommendations will be provided to the Director.

LPAs conducted an exit interview with Director and provided a copy of this report. A Notice of Site Visit was issued during this inspection. Director understands that the Notice of Site Visit must remain posted for the next 30 days.



No deficiencies were cited during this tele-inspection.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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 1