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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210591
Report Date: 12/17/2024
Date Signed: 12/17/2024 10:15:40 AM

Document Has Been Signed on 12/17/2024 10:15 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
566210591
ADMINISTRATOR/
DIRECTOR:		REBECCA DELGADOFACILITY TYPE:
850
ADDRESS:261 WEST STANLEYTELEPHONE:
(805) 652-0917
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 32DATE:
12/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:59 AM
MET WITH:Rebecca DelgadoTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
NARRATIVE
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On 12/17/2024 LPA Negrete made an unannounced visit to complete a case management deficiency inspection. LPA met with Administrator Rebecca Delgado. LPA toured the facility inside and out. LPA observed 32 children being supervised by 6 staff.

On 12/12/2024 LPA conducted a inspection in order to initiate a complaint investigation. LPA conducted/completed a LIC859 staff file review. LPA discovered S1 had a incomplete personal record.

The following deficiency Personal Records, Section 101217(a)(3)(6)(11) is being cited today. See attached LIC 809D:

Exit interview was conducted, report was reviewed with Administrator Rebecca Delgado.

Appeal rights were provided.

Notice of site visit was given at the conclusion of the inspection. The notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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Document Has Been Signed on 12/17/2024 10:15 AM - It Cannot Be Edited


Created By: German Negrete On 12/17/2024 at 09:37 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 566210591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2024
Section Cited
CCR
101217(a)(3)(6)(11)

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The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (3) Date of employment.Documentation of the educational background, training and/or experience specified in this chapter.
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Licensee will email personal records of 4 qualified teachers. Those teachers will be selected by the departmennt by the end of 12/17/2024. Licensee will receive a email by the end of 12/17/2024. The email will have the names of the four teachers.
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(11) A health screening as specified in Section 101216(g)..... Due to file review, LPA's observations, this regulation was not met on 12/12/2024 by the Licensee. S1 had a incomplete file/personal record. S1 wa missing the aforementioned documents.
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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:Ana Tolentino
LICENSING EVALUATOR NAME:German Negrete
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
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