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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809116
Report Date: 09/09/2024
Date Signed: 09/30/2024 05:03:05 PM

Document Has Been Signed on 09/30/2024 05:03 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:
364809116
ADMINISTRATOR/
DIRECTOR:		KECIA LOVINGFACILITY TYPE:
830
ADDRESS:14040 BEAR VALLEY ROADTELEPHONE:
(760) 241-4748
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
09/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Kecia LovingsTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On September 9, 2024, Licensing Program Analyst (LPA), Calloway made an unannounced case management inspection to the above facility. LPA met with facility representative who granted access. LPA observed ninety (90) day care children and eight representatives and inside the day care center and inside the infant room there were eight (8) infants with two representatives in active care during the inspection.

LPA was in the facility to conduct an annual inspection for 364801075 preschool license and did a walk through of the facility. During the walk through, LPA observed two infants sleeping on their stomachs and neither one of them had the LIC 9227 form or an indication on their Infant and Toddler Care Plan, signed by the parent, stating they could roll on their stomach from their backs.

Per Title 22 regulations there is a TYPE A deficiency cited for Safe Sleep regulations. See 809-D page attached to this report.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed acknowledgment of Licensing Reports (LIC-9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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Document Has Been Signed on 09/30/2024 05:03 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/09/2024 at 04:08 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: 364809116

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2024
Section Cited
CCR
101429(a)(2)(B)3

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101429 Responsibility for Providing Care and Supervision for Infants(a) In addition to Section 101229, the following...(2)Sleeping infant(s) shall be directly observed...(B)Staff shall physically check ...3)Infants up to 12 months of age...This requirement is not met as evidence by:
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Licensee will provide proof in writing of how to prevent the incident from reoccurring in the future.
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Based on observation and record review, LPA observed two infant sleeping on their stomach with two staff present and no documentation in their file they were able to roll from their back to stomach which poses an immediate health, safety, or personal rights risk to the persons 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:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 364809116
VISIT DATE: 09/09/2024
NARRATIVE
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Exit interview was conducted, a copy of this report was read and a Notice of Site Visit, Appeal Rights were provided to Kecia Lovings, Facility Representative during this inspection. The Notice of Site Visit form must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
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