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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624031
Report Date: 07/12/2022
Date Signed: 07/13/2022 11:05:34 AM

Document Has Been Signed on 07/13/2022 11:05 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 INC.FACILITY NUMBER:
343624031
ADMINISTRATOR:PERKINS, SUSANFACILITY TYPE:
840
ADDRESS:3100 MACON DRTELEPHONE:
(916) 665-0274
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 23DATE:
07/12/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Susan PerkinsTIME COMPLETED:
03:45 PM
NARRATIVE
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 On July 12th, 2022 at 2:00PM, LPA Pascual met with Facility Representative to deliver complaint findings for the allegation above. Upon arrival, LPA observed 28 students in care and two staff.

LPA made an unannounced visit to deliver findings for a complaint. During the investigation process, it was found that the Facility Representative did not report an absence of supervision that had occurred with a child, who was left alone napping while the entire class and staff were outside.

This is a reportable unusual incident report that did not occur.

Based on this information obtained this is a B citation.

LPA discussed this report with facility representative and conducted an exit interview. LPA also provided appeal rights. Notice of site visit posted.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
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 07/13/2022 11:05 AM - It Cannot Be Edited


Created By: Michelle Pascual On 07/12/2022 at 02:37 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LA PETITE ACADEMY INC.
FACILITY NUMBER: 343624031

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2022
Section Cited
CCR
101212(d)(1)

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.....seven day written.
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Facility Representative understands Reporting Requirements and will submit a letter explaining the understanding with a signature.
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This was not evidenced by the department receving an unsual incident report of the absence of supervison.
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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:Roxana Saravia
LICENSING EVALUATOR NAME:Michelle Pascual
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022


LIC809 (FAS) - (06/04)
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