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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600101
Report Date: 12/29/2022
Date Signed: 12/29/2022 02:48:00 PM

Document Has Been Signed on 12/29/2022 02:48 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMY INCORPORATEDFACILITY NUMBER:
376600101
ADMINISTRATOR:RIVAS, OBDULIAFACILITY TYPE:
830
ADDRESS:725 SHADOWRIDGETELEPHONE:
(760) 727-0648
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 12DATE:
12/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Obdulia RivasTIME COMPLETED:
02:55 PM
NARRATIVE
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On December 29, 2022 at 1:35 PM, Licensing Program Analysts (LPAs) Jessica Rubio and Courtnee Peebles, conducted a follow-up case management visit to the case management visit conducted on October 25, 2022 which was in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPAs met with Obdulia Rivas, Site Director (SD) who was informed the reason for the visit.

Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing.

LPAs observed on the report provided by the SWRCB, Faucet C, Faucet D and Faucet H identified as having high levels of lead. The faucets are located in the Toddler 1 and Toddler 2 classrooms. SD stated that the faucets were only used for hand washing, were immediately turned off and placed out of service. The faucets have been replaced and retested.

See LIC 809D for cited deficiency in accordance with the California Code of Regulations Title 22, Division 12 written directives.

An exit interview was conducted with Obdulia Rivas. A copy of this report, appeal rights and a Notice of Site Visit was issued.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2022
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 12/29/2022 02:48 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 12/29/2022 at 02:29 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LA PETITE ACADEMY INCORPORATED
FACILITY NUMBER: 376600101

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2022
Section Cited

101700.3(b)(1)

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up...(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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Director stated faucets were replaced, retested and are no longer deemed exceeding. Deficiency has been corrected.
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LPA Rubio received the facilities water testing results for faucets with an Action Level Exceedance higher than the allowable limit.
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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:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022


LIC809 (FAS) - (06/04)
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