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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600096
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:57:36 PM

Document Has Been Signed on 10/15/2021 01:57 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: 76DATE:
10/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Celine Derothschild, Facility RepresentativeTIME COMPLETED:
01:57 PM
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On October 15, 2021 at 12:50 PM, Licensing Program Analyst (LPA), Marie Hernandez, conducted a case management visit pertaining to a personnel matter. LPA met with the Facility Representatives, Celine Derothschild, and Tara Reese.

The Facility Representative was provided the facility evaluation report, and the notice of site visit. The Representative was advised that the notice of site visit must be posted in a prominent place for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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