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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624029
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:13:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2023 and conducted by Evaluator Matthew Gallo
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20231004151451
FACILITY NAME:LA PETITE ACADEMY INC.FACILITY NUMBER:
343624029
ADMINISTRATOR:PERKINS, SUSANFACILITY TYPE:
830
ADDRESS:3100 MACON DRTELEPHONE:
(916) 665-0274
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:40CENSUS: 6DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mornen HaymerTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Personal Rights: Staff did not ensure infant's diapering needs were met.
INVESTIGATION FINDINGS:
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At 8:40am on 10/10/2023, Licensing Program Analyst (LPA) Matthew Gallo arrived at facility for the purpose of opening and closing a complaint investigation into the above allegation. Upon arrival, LPA observed a census of 6 children supervised by 4 staff. Director Mornen Haymer arrived during LPA's inspection.

It was alleged that staff did not ensure infant's diapering needs were met. Throughout investigation, LPA conducted observations, record review, and interviewed staff. Through record review, LPA determined that a child who was checked in at 10:28am on 10/4/2023 had been logged as having received a diaper check at 10:56am, which was dry, and a diaper change at 12:00pm when a second check revealed their diaper to be wet. However, information gained from staff interviews confirmed complainant's allegation that the child remained in the same diaper they were dropped off in until they were checked out at 2:02pm. Interviews with staff also provided facts confirming a breakdown in staff communication whereby diaper cream was not applied according to medical treatment instructions on file, as was alleged by complainant.

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 03-CC-20231004151451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 343624029
VISIT DATE: 10/10/2023
NARRATIVE
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The preponderance of evidence standard has been met, and therefore the allegation that staff did not ensure infant's diapering needs were met is SUBSTANTIATED. A Title 22 deficiency is cited on the following 9099-D.

Exit interview conducted and report was reviewed with Director Mornen Haymer. A notice of site visit was given and must remain posted for 30 days. Appeals right provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20231004151451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 343624029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2023
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations...to meet his/her needs. This requirement was not met, as evidenced by:
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Director will conduct training reaffirming proper diaper changing protocol and send LPA Gallo copies of agenda along with staff signatures acknowleding attendance by the POC due date.
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Through record review and interview, LPA determined that a child who had been checked in on 10/4/2023 at 10:28am remained in the same diaper until they were checked out at 2:02pm, at which point the diaper was wet. This 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.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3