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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364801075
Report Date: 10/17/2023
Date Signed: 10/17/2023 04:47:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2023 and conducted by Evaluator Kristina Diaz
COMPLAINT CONTROL NUMBER: 12-CC-20230615101643
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:118CENSUS: 77DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Kecia LovingTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Neglect/Lack of Care and Supervision
INVESTIGATION FINDINGS:
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On October 17, 2023 at 12:43 pm Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced complaint inspection and met with the Facility Representative. The purpose of the inspection was to deliver findings for a complaint investigation at the licensed facility regarding the above allegations. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Facility Representative and guided on a tour of the facility for a safety inspection. At the time of the visit there were 77 preschool age children in care including 8 infants, 5 preschool teachers, 2 infant teachers and additional support staff present at the facility.

On June 15, 2023, the Department received allegations alleging that on June 13, 2023, C1 was injured in care. It is also alleged that staff failed to notify C1s authorized representative, P1, in a timely manner. As a result of the injury, C1 sustained a fractured right clavicle. Investigator Dennis Seng of the department's Investigation Bureau (IB) conducted the investigation.
Cont'd on 9099-C
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 12-CC-20230615101643
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 ACADEMY
FACILITY NUMBER: 364801075
VISIT DATE: 10/17/2023
NARRATIVE
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Based on file reviews, medical records, and interviews Investigator Seng confirmed that C1 sustained a serious injury while in care and staff failed to contact C1s authorized representative, P1, in a timely manner.

Based on Investigators observations, interviews conducted, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

California Code of Regulations (Title 22 regulation - see LIC 9099D) which requires staff to ensure all children can be visually observed at all times while in care.
One Type A deficiency and civil penalty will be assessed in the amount of $500 for C1 sustaining a serious injury while in care at the facility. A Type A deficiency will also be assessed for staff's failure to notify C1s authorized representative of a serious injury in a timely manner.

Exit interview conducted with Facility Representative, Kecia Loving. A copy of this report,
appeal rights and notice of site visit were left with the Facility Representative.
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
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 12-CC-20230615101643
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 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)
Type A
10/17/2023
Section Cited
CCR
101229(a)(1)
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101229 - Responsibility for Providing Care and Supervision (a) The licensee shall
provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision
of a teacher at any time... Supervision shall include visual observation. This requirement
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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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was not met as evidenced by: Based on observation , interviews, and record review staff did not ensure childwas visually observable at all times resulting in serious injury which poses an immediate health, safety, and personal rights risk to children in care.
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Type A
10/17/2023
Section Cited
CCR
101226(b)(c)
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101226 - Health-Related Services
(b) The licensee shall make prompt arrangements for obtaining medical treatment for any child if necessary.
(c) The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized
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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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representative...if the nature of the child's child's illness or injury is such that there should be no delay in getting medical treatment for the child. This requirement was not met as evidenced by:Staff not contacting C1s authorized representative for several hours following C1s injury. This poses immediate 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.
SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Claretta Yates
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
LIC9099 (FAS) - (06/04)
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