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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600096
Report Date: 04/28/2022
Date Signed: 04/28/2022 09:09:50 PM

Document Has Been Signed on 04/28/2022 09:09 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 ACADEMY - EAST JFACILITY NUMBER:
376600096
ADMINISTRATOR:CELINE DEROTHSCHILDFACILITY TYPE:
850
ADDRESS:798 EAST J STREETTELEPHONE:
(619) 421-0966
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: DATE:
04/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Tara ReeseTIME COMPLETED:
01:30 PM
NARRATIVE
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On April 28, 2022, at 11:30 AM, Licensing Program Analyst (LPA), Adrian Castellon, conducted an unannounced Case Management Inspection to investigate a self reported incident. On 04/20/2022, the Department received a telephone call from the facility for child #1. The call from Director Reese indicated that child #1 was left unattended for ten minutes. LPA Castellon met with the director Reese on this date. LPA conducted several interviews with the staff and the Director.

The facility reported that on 04/19/2022 at 4:30 PM, child #1 was located outside unsupervised on the 2's playground by another teacher. On the day of the incident, there were seven children with one staff. Child #1's class was outside on the playground having a snack. Child #1 was left out on the playground by staff as class returned to class. Staff did not follow required face to name procedure. The Director stated the parent of child #1 was advised of the incident. Child #1 did not sustain any injuries. LPA inspected the classroom and playground for safety hazards and did not observe any at time of visit. The staff and the Director were proactive by tending to child’s needs when the child was located. The incident was reported in a timely manner to the licensing office. A type A citation will be issued on this date. Please see LIC809D.

An exit interview was conducted and the report was provided to the facility director Tera Reese. LIC9224 reporting requirements were discussed.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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 04/28/2022 09:09 PM - It Cannot Be Edited


Created By: Adrian Castellon On 04/28/2022 at 12:47 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LA PETITE ACADEMY - EAST J
FACILITY NUMBER: 376600096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2022
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the children's needs(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall
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Director Reese states that staff member who was responsible for the supervision of child#1 is no longer employed at the facility. A meeting will be held on 5/14 where face to name procedures will be discussed. Supervision requirement regulation will also be discussed. Director will submit a signed attendance sheet as part of the plan of correction.
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include visual observation. This requirement was not met as evidenced by child in care was left unattended in the playground for at least 10 minutes. This poses an immediate threat to the health and safety of 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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022


LIC809 (FAS) - (06/04)
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