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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600099
Report Date: 03/13/2025
Date Signed: 03/13/2025 10:05:13 AM

Document Has Been Signed on 03/13/2025 10:05 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMY INCORPORATEDFACILITY NUMBER:
376600099
ADMINISTRATOR/
DIRECTOR:		MICHELLE MCKIMFACILITY TYPE:
850
ADDRESS:725 SHADOWRIDGE DR.TELEPHONE:
(760) 727-0648
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 40DATE:
03/13/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Kristin O'Connor, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On March 13, 2025, at 9:15 AM, Licensing Program Analyst (LPA) William Chancellor arrived unannounced at La Petite Academy (CCC) to conduct a Case Management Visit regarding an unusual incident report received on October 31, 2024. The report involved Child 1 (C1) falling from a playground structure, prompting emergency services to be called. LPA met with Assistant Director (AD) Kristin O’Connor and explained the purpose of the visit.

During the initial case management visit on November 8, 2024, LPA interviewed staff, conducted observations, and requested documentation related to the incident. Staff interviews confirmed that the staff member who witnessed the incident was inside and not within ratio outside with C1 at the time. A record review indicated that the CCC may have been following the required 1:12 ratio at the time of the incident. However, manufacturer guidelines for the play structure specify that adults should be actively engaged in supervising children while it is in use.

Interviews further revealed a lack of supervision at the time of the incident, as Staff 2 (S2) was occupied addressing another situation involving two children attempting to climb over a chain link fence separating playgrounds. The record review confirmed that the play structure is designed for children aged 2 to 12 years. However, the incident may have been preventable if staff had been actively supervising and had observed C1’s initial attempt to climb over the top of the slide.

Based on interviews and records reviewed, a deficiency is being cited under California Code of Regulations Title 22, Section 101229(a)(1): Responsibility for Providing Care and Supervision. See LIC 809-D for cited deficiencies.

An exit interview was conducted, and Assistant Director, Kristin O’Connor was provided with a copy of this report, appeal rights, and a Notice of Site Visit. The Notice of Site Visit must be posted in a prominent location for 30 consecutive days, visible to families and caregivers.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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 03/13/2025 10:05 AM - It Cannot Be Edited


Created By: William M Chancellor Jr. On 03/13/2025 at 09:46 AM
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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LA PETITE ACADEMY INCORPORATED
FACILITY NUMBER: 376600099

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2025
Section Cited
CCR
101229(a)(1)

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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, … Supervision shall include visual observation.
This requirement was not met as evidenced by:
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On 11/8/24, the Director immediately implemented the use of an alternative playground designated for infants and toddlers for the two-year-old classroom. The Director also submitted a revised plan of operations and an updated facility sketch.
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Based on interviews and record reviewed, it was revealed that staff were not actively engaged or supervising child 1 (C1) when utilizing the play structure slide. Child 1 fall from the top of the slide could have been prevented if staff were actively supervising C1 from climbing over the top of the slide. This poses a potential health, safety, or personal rights risk to persons in care.
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By the close of business on 4/11/25, the Director will email LPA an agenda and staff sign-in sheet for a training session on playground safety and active supervision. The training will cover potential hazards, preventive measures, and designated supervision zones to help prevent future injuries.

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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:Pauline Beschorner
LICENSING EVALUATOR NAME:William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2025


LIC809 (FAS) - (06/04)
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