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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801075
Report Date: 10/17/2023
Date Signed: 10/17/2023 04:46:40 PM

Document Has Been Signed on 10/17/2023 04:46 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:KECIA LOVINGFACILITY TYPE:
850
ADDRESS:14040 BEAR VALLEY ROADTELEPHONE:
(760) 241-4748
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 118TOTAL ENROLLED CHILDREN: 118CENSUS: 77DATE:
10/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Kecia LovingTIME COMPLETED:
04:50 PM
NARRATIVE
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On October 17, 2023, LPA Diaz met with Facility Representative, Kecia Loving, who granted access to the facility and escorted LPA on a tour. The purpose of the visit was to conduct an unannounced case management inspection. At the time of the inspection, LPA observed 77 preschool children in care including 8 infants with 7 teachers and other support staff at the facility.

On June 16, 2023 the Department received a complaint alleging C1 sustained a fractured right clavicle while in care and C1 was not visually observable at the time of injury. It is also alleged that staff did not contact C1s authorized representative in a timely manner to notify of injury. The complaint was investigated by the department's Investigation Bureau (IB) and it was determined that the above allegations were true.

Based on staff interviews conducted by IB Investigator Dennis Seng it is determined that S1 was left alone with 24 children. S2 and S3 were on break at the time of the incident. It is further determined that S1 was not able to visually observe all 24 children and was unaware that C1 was seriously injured until C1 disclosed this information to S1.

The facility is cited a Type A deficiency, per the California Code of Regulations, Title 22, Division 12.
See Facility Evaluation Report LIC809-D for deficiency cited.

An exit interview was conducted with Facility Representative and a copy of report, notice of site visit, and appeal rights were given.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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 10/17/2023 04:46 PM - It Cannot Be Edited


Created By: Kristina Diaz On 10/17/2023 at 03:37 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 364801075

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/17/2023
Section Cited
CCR
101216.3(a)

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101216.3 - Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance

This requirement was not met as evidenced by:
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Per Facility Representative, immediately following the incident a training was conducted on playground supervision. Representative will provide LPA with proof of completion by COB 10/27/2023.
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Based on observation, interviews, and record review staff did not ensure there was more than 1 teacher supervising 24 children in care which poses an immediate
health, safety, and personal rights risk to children 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.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kristina Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023


LIC809 (FAS) - (06/04)
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