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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801075
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:11:32 PM

Document Has Been Signed on 07/27/2023 03:11 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
364801075
ADMINISTRATOR:TAMMY ESQUIVELFACILITY TYPE:
850
ADDRESS:14040 BEAR VALLEY ROADTELEPHONE:
(760) 241-4748
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 118TOTAL ENROLLED CHILDREN: 118CENSUS: 88DATE:
07/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Facility Representative Kecia Loving TIME COMPLETED:
03:30 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 July 27, 2023, at 2:01 p.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced case management deficiency inspection and met with facility representative Kecia Loving. LPA disclosed the purpose of the inspection and was granted entry into the facility. 88 preschool children, seven teachers and additional staff were present in the facility during this inspection.

On July 26, 2023, the Department was informed of an incident that occurred at the Center in February 2023. The incident was regarding a potential personal rights violation that involved child 1 (C1) and staff 1 (S1). According to the information received, parent 1 (P1) informed the management team that while reviewing the live streaming option on the Sprout About App, P1 observed S1 grab C1 by the wrists and force C1 to sit at the table. After P1 made the management team aware of the incident S1 was placed on administrative leave while the management team conducted an internal investigation. Staff interviews reported they were unsure if this incident was reported to the Department. LPAs review of the facility file showed zero evidence that the Center reported this incident to the Department. This incident was unusual and threatened the physical, and emotional health or safety of C1, therefore the incident was required to be reported to the Department. The facility failed to meet the reporting requirements. A deficiency is being cited based on the LPA record review and interviews in accordance with the California Code of Regulations, Title 22, see LIC809D.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with facility representative Kecia Loving.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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 07/27/2023 03:11 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 07/27/2023 at 01:53 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 364801075

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
CCR
101212(d)(1)(C)

1
2
3
4
5
6
7
101212 Reporting Requirements (d) …during the operation of the child... (1) Events reported... (C) Any unusual incident or child absence that threatens the physical or emotional health...of any child. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per facility representative, Tittle 22 Reporting Requirements will be reviewed by the staff. Documentation that the reporting requirements were reviewed will be submitted to the Department. The facility will met the reporting requirements from this day forward
8
9
10
11
12
13
14
Based on interviews and record review, in February 2023 the Center failed to report an incident involving S1 grabbing the wrists of C1. This incident threatened the physical or emotional health of C1. This posed a potential Health, Safety, and Personal Rights risk to persons 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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023


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