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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801075
Report Date: 05/24/2022
Date Signed: 05/24/2022 02:21:36 PM

Document Has Been Signed on 05/24/2022 02:21 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, 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: 22DATE:
05/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Keisha Loving Assistant DirectorTIME COMPLETED:
02:29 PM
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Licensing Program Analyst (LPA) Steven Montoya conducted an unannouced CM visit to follow up on an child injury report dated: 4-11-2022. LPA met with Assistant Director Keisha Loving, who provided a tour of the child care center. AD reports the injured child is currently still attending and enrolled with the CCC. AD reports site surveillance video is no longer available for viewing due to system term. AD reports the parent was aware of the investigation by La Petite management and no further investigation is being conducted. LPA planned to interview injured child however at the time child was napping.

LPA requested copy of Updated Child Care Roster and attendance sheet for the date of the incident.

Exit.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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