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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500454
Report Date: 10/28/2024
Date Signed: 10/28/2024 02:35:57 PM

Document Has Been Signed on 10/28/2024 02:35 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
344500454
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, ASHLEYFACILITY TYPE:
850
ADDRESS:8160 SHELDON ROADTELEPHONE:
(916) 684-4222
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: 42DATE:
10/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Ashley SanchezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 10/28/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection regarding a self reported Unusual Incident Report (UIR) dated 10/18/2024. LPA arrived at the facility and was met by Director Ashley Sanchez (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 42 preschool aged children being supervised by 5 staff members during nap time. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

LPA conducted staff interviews and reviewed documentation. Information revealed what was reported to the Department in the UIR: On 10/18/2024, a child was injured on the playground which resulted in the child's fingertip being severed off.

An exit interview was conducted, and the report was reviewed with Director Sanchez. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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