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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600083
Report Date: 04/12/2023
Date Signed: 04/12/2023 04:12:03 PM


Document Has Been Signed on 04/12/2023 04:12 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
376600083
ADMINISTRATOR:NANISSA MADADIFACILITY TYPE:
850
ADDRESS:12668 SABRE SPRINGS PARKWAYTELEPHONE:
(858) 486-7197
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:123CENSUS: 62DATE:
04/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Nanissa MadadiTIME COMPLETED:
03:07 PM
NARRATIVE
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On 4/12/23 at 2:30 PM, LPAs Annette Sutherland and Adrian Mangina made an unannounced Case- Management deficiency visit. LPAs met with Director Nanissa Madadi and toured facility . LPAs explained reason for visit. Director did not report an incident that occurred at the facility on 4/7/23 . Facility also had expired allergy medication at facility.

Incident was reported to department as a complaint. LPAs explained unusual incident reporting (LIC 624) to Nanissa Madadi and timeline .

See LIC809D for type B deficiencies cited.

The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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 04/12/2023 04:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 376600083

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2023
Section Cited

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376600083 (d) Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement is not met as evidenced by:
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Director has provided correction on today's visit. She will ensure that in the future incidents are reported on the duty line (619)767-2248 and submit an incident report by email to SDIncidentReports@dss.ca.gov or by Fax at (619 767-2203 within 24 hours of occurring.
Licensee will also provide written statement explaining that she will submit future reports per the required time frames to LPA Annette.Sutherland@dss.ca.gov
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This requirement was not met as evidenced by the department did not receive an incident report within 24 hours. This poses a potential health and safety risk to children in care.
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Type B
04/14/2023
Section Cited

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101226 Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met:
(A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.This requirement is not met as evidenced by:
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Director will provide a written statement to explain procedures and how medication dates will be tracked.
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This requirement was not met as evidenced by medication has expired. This poses a potential health and safety 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.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
LIC809 (FAS) - (06/04)
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