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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809116
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:59:59 PM

Document Has Been Signed on 11/05/2024 04:59 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: 7DATE:
11/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:33 PM
MET WITH:Linda MezaTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On November 5, 2024, Licensing Program Analyst (LPA), Calloway conducted an unannounced case management inspection to the above facility. LPA met with the facility representative who granted access. LPA toured the facility with the representative and observed seven infants in care children with two facility representatives.

On October 1, 2024, Child 1 (C1) lost their balance while holding onto a metal gate and fell inside the infant room hitting the back of their head and suffered a head injury. C1 sustained a cut and bruise to the back of the head that was bleeding, and medical attention was provided by staff. C1’s parent sought further medical treatment at the hospital. The unusual incident was not reported by LA Petite Academy’s staff to Community Care Licensing Division- Palmdale Region Office.

Per Title 22, Division 12, Chapter 1, there is one Type B deficiency cited for 101212 (d)(1)(B) for Reporting Requirements. See 809D page attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeal Rights were provided to Linda Meza, Facility Representative at the facility. A Notice of Site Visit 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: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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 11/05/2024 04:59 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 11/05/2024 at 04:38 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: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2024
Section Cited
CCR
101212(d)(1)(B)

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101212(d)(1)(B)- Reporting Requirements: ..during the operation of the child care center..report shall be made...(1) Events reported shall include the following: (B)... injury to any child that requires medical treatment. This requirement was not met as evidenced by:

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Faciltiy representative stated, moving forward an incident report will be submitted and immediately reported within 24 hours and sent to the LIcensing Department. I will review the regulations and policies and procedures and provide proof by writing a statement staing that I have reviewed policies by POC date
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Based on interviews and record reviews Child 1 sustained a head injury while in care that required further medical treatment and the incident was not reported to the Licensing Department which poses a potential 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: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2024


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