Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403397
Report Date: 04/27/2015 12:00:00 AM
Date Signed 04/27/2015 01:51:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LA PETITE ACADEMY SAN RAMON - INFANTFACILITY NUMBER:
073403397
ADMINISTRATOR:ABASTA-CASTRO, MARICARFACILITY TYPE:
830
ADDRESS:1001 MARKET PLACETELEPHONE:
(925) 277-0626
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:28CENSUS: 13DATE:
04/27/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:MaricarTIME COMPLETED:
10:00 AM
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(1) Annual random visit conducted by Licensing Program Analyst, Jason Jang. A tour of the facility was made and the buildings and grounds were inspected. All of the correct postings were on the wall. The sign in sign out sheet, first aid kit, snack menu, and fire drill log book were reviewed and found to be complete. Children and staff files were reviewed. The facility was within ratio. Proper lighting and a comfortable temperature was noted in both classrooms. Staff had a current cpr and first aid certificate.

There were no deficiencies cited in today's visit.
SUPERVISOR'S NAME: Zakiya AliTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jason JangTELEPHONE: (510) 622-2621
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2015
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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