<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809116
Report Date: 01/22/2025
Date Signed: 01/22/2025 05:04:24 PM

Document Has Been Signed on 01/22/2025 05:04 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:
01/22/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:40 PM
MET WITH:Samantha BrownTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On January 22, 2025, Licensing Program Analyst (LPA), Calloway conducted an unannounced case management at the above facility. LPA observed seven infants in care and two staff members.

LPA toured the facility during an annual inspection for the school aged component and observed five infants ages twelve to sixteen months sleeping on cots on their stomachs and four of the children did not have the LIC 9227 form in their files that stated they could roll. Per the representative, the children were on the cots due to they are able to stand up in the cribs and put a leg up to climb out.

There is a Type B deficiency issued during this inspection. See 809 D page attached to this report.

An exit interview was conducted and a copy of this report and a Notice of Site Visit, and Appeal Rights were provided to Samantha Brown, Facility Representative during the inspection. Failure to maintain posting for thirty (30) consecutive days may result in a $100 civil penalty being assessed.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/22/2025 05:04 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 01/22/2025 at 04:46 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: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2025
Section Cited
CCR
101430(a)(3)(A)(4)

1
2
3
4
5
6
7
101430 Infant Care Activities
(a) Notwithstanding Section 101230, the following shall apply:(3) All infants shall be given ....to sleep...(A) Staff shall place infants up to 12 month of age on their backs for sleeping. 4. Infants with an ...[LIC 9227 ..Section C of the form completed...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Per facility representative they will have the parents complete the form and submit to the Licensing office by the correction date.
8
9
10
11
12
13
14
Based on observation, interview, and record review five infants were observed sleeping on cots in the infant room on their stomachs without the LIC 9227 form signed in their files which poses a potential health, safety, or personal rights risk to the persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2