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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600083
Report Date: 05/22/2023
Date Signed: 05/22/2023 09:51:49 AM

Document Has Been Signed on 05/22/2023 09:51 AM - 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: 123TOTAL ENROLLED CHILDREN: 123CENSUS: 70DATE:
05/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria RuvalcabaTIME COMPLETED:
10:00 AM
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On 5/22/23 at 9:15 AM Licensing Program Analyst LPA Adrian Mangina conducted a case management for the purpose of conducting staff interviews regarding past employees. LPA met with School Education Manager Maria Ruvalcaba as Director was not in at the time. During the visit there were 70 children in care with 10 teachers in 6 classrooms. Proper ratios and supervision were observed

During the visit, LPA obtained LIC855 Declaration Forms from staff and reviewed staff files. LPA was unable to conduct additional staff interviews due to requested staff was not at the facility at the time of the visit. No deficiencies cited. Exit interview conducted and report was reviewed with the facility representative, Maria Ruvalcaba. The Facility Representative was provided a copy of this report. A Notice of Site Visit (LIC9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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