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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600099
Report Date: 11/08/2024
Date Signed: 11/08/2024 12:54:34 PM

Document Has Been Signed on 11/08/2024 12:54 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMY INCORPORATEDFACILITY NUMBER:
376600099
ADMINISTRATOR/
DIRECTOR:
RIVAS, OBDOLIAFACILITY TYPE:
850
ADDRESS:725 SHADOWRIDGE DR.TELEPHONE:
(760) 727-0648
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 65DATE:
11/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Michelle McKim, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On November 8, 2024 at 8:40AM, Licensing Program Analyst (LPA) William Chancellor arrived unannounced to the La Petite Academy (CCC). The purpose of the visit was to conduct a case management regarding an unusual incident report received on 10/31/24. The incident involved a child (C1) falling off a playground structure and emergency services were called. LPA met with Director (DIR) Michelle McKim and stated the reason for the visit.

During the visit, LPA conducted interview's with three staff (S1- S3), one child (C1), made observations of the playground and requested documents regarding the incident. Two of two interviews, revealed that staff were in ratio at the time of the incident and S2 witnessed the incident. Three of three interviews corroborated that C1 fell off the top of the slide, falling down approximately six feet, onto their back.

Facility notified the parents of C1 immediately and child obtained medical attention in a timely matter. No concerns were determined by emergency personnel and C1 returned the next day without restrictions. To improve supervision, DIR immediately implemented a solution that C1 toddler classroom, have access to a different playground when outside. Based on the information gathered, LPA is unable to determine if the facility is or is not in violation of Title 22 Regulations at this time. The following documents are pending review by Community Care Licensing (CCL): playground structure manual confirming age restrictions and confirmation that all play structures on the facilities premise are still approved by the United States Consumer Product Safety Commission.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Director Michelle McKim. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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