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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600873
Report Date: 08/04/2022
Date Signed: 08/04/2022 11:04:46 AM

Document Has Been Signed on 08/04/2022 11:04 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LA PETITE ACADEMY - CITRUS HEIGHTSFACILITY NUMBER:
343600873
ADMINISTRATOR:JENKINS, JULIEFACILITY TYPE:
850
ADDRESS:8008 OLD AUBURN ROADTELEPHONE:
(916) 723-3094
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 77TOTAL ENROLLED CHILDREN: 77CENSUS: 41DATE:
08/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Julie JenkinsTIME COMPLETED:
11:20 AM
NARRATIVE
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At 9:50 a.m. on Thursday, August 4th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Julie Jenkins, for the purpose of an unannounced case management - incident inspection. During today's inspection, LPA reviewed documents and storage of medications. On July 29th, 2022, the facility self reported an incident that occurred on July 28th, 2022. It was detailed that a child (C1) was administered medication that was prescribed for another child (C2). It was stated that the medication was similar looking, and some medication had spilled to cover the label. Director stated that the parent of C1 was immediately notified when the error was discovered, and outreach to C1's doctor was conducted. Director stated that C1 remained in attendance since their doctor did not have any concerns since the two medications were similar, a full dose was not received, and there was no reaction observed in the child. Per Unusual Incident Report received, follow up training has been conducted for management.

Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days for parental review.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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 08/04/2022 11:04 AM - It Cannot Be Edited


Created By: Karyn Guerra On 08/04/2022 at 10:31 AM
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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LA PETITE ACADEMY - CITRUS HEIGHTS
FACILITY NUMBER: 343600873

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2022
Section Cited
CCR
101226(e)(3)(A)

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101226 Health-Related Services (e) In centers where the licensee chooses to handle medications: (3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement was not met, as evidenced by:
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It was documented in the UIR received that follow up training was conducted. Director stated that only managers are allowed to administer medication. POC cleared during today's inspection.
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Based on interviews and reports Child 1 (C1) was administered medication that was not prescribed to them, and was instead prescribed for another child (C2). This poses an immidiate health and safety risk to children 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Karyn Guerra
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


LIC809 (FAS) - (06/04)
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