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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500453
Report Date: 07/06/2022
Date Signed: 07/06/2022 01:34:25 PM

Document Has Been Signed on 07/06/2022 01:34 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
344500453
ADMINISTRATOR:BECKSTROM, MICHELEFACILITY TYPE:
830
ADDRESS:8160 SHELDON ROADTELEPHONE:
(916) 684-4222
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 34DATE:
07/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michele BeckstromTIME COMPLETED:
01:45 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 07/06/2022, Licensing Program Analyst Katy Maestas (LPA) conducted a field visit to the facility for the purpose of a Case Management inspection related to elevated levels of lead in the water. LPA arrived at the facility and disclosed the purpose of the inspection and was granted entrance into the facility by the District Manager, Rosie Tichauer (D1). D1 was managing the facility in the absence of Director Michele Beckstrom (D2) who was off-site supervising a field trip. D2 arrived at the facility at approximately noon. LPA toured the facility and 9 staff members were supervising 34 children. LPA determined, through accessing Guardian, that all adults who were supervising children were clear and associated with the license.

The Regional Office was notified of the elevated levels of lead in the facility's water on 06/28/2022 via email from the CCC Water Testing Department. D2 was unaware of the elevated levels of lead and has not received a report based on the testing that occurred on 06/14/2022 by Krizia Kolakowski, Department of Public Health. LPA notified D2 of the results of the testing and the faucet, which the sample was taken from, was immediately taped off and made inaccessible for use. D2 stated that the faucet was not being used prior to the testing since it is located in a toddler classroom. The toddlers are given water from a Brita filtered pitcher to consume and hand washing does not occur at this water outlet as the children in this classroom are in diapers.

During today's inspection, LPA verified that the affected water outlet is not in use. D1 and D2 said that they would contact their maintenance office today to begin scheduling a repair of this water outlet. LPA reminded D2 that the water will have to be flushed and re-tested from the outlet, once it is repaired. LPA must be informed of updates related to the repair, and results of the additional water testing must be reported to the Regional Office. As a result of the water testing positive for lead, a deficiency was cited on subsequent page 809D. An exit interview was conducted and the report was reviewed with D2 Licensee Appeal Rights were provided. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2022
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 2
Document Has Been Signed on 07/06/2022 01:34 PM - It Cannot Be Edited


Created By: Nola Maestas On 07/06/2022 at 01:17 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
FACILITY NUMBER: 344500453

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2022
Section Cited
CCR
101238(a)

1
2
3
4
5
6
7
101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director will schedule maintanence to repair the water outlet as soon as possible. Director will schedule re-testing of the water after the repairs have been completed. LPA will follow-up with the facility once re-testing results have been reported to LPA.



8
9
10
11
12
13
14
The water tested on 06/14/2022 revealed that the facility had elevated levels of lead in one water faucet. This is a violation, that if not corrected, can pose a health and safety risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Jeanne Smith
LICENSING EVALUATOR NAME:Nola Maestas
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2