Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403397
Report Date: 05/17/2016
Date Signed 05/17/2016 11:37:53 AM

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: 12DATE:
05/17/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Maricar Abasta-CastroTIME COMPLETED:
11:45 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. Licensee was reminded that anyone working at the facility must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. Also discussed: nutrition education; the new appeal process; and documents to be provided to parents/legal guardians. This facility provides Incidental medical services-IMS. LPA reviewed the storage of medication and equipment /supplies, and reviewed children and personnel records. LPA discussed the need to create a plan of operation. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173 Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. Exit interview conducted. Licensee was provided a copy of their appeal rights. Notice of site visit was posted at the time of the inspection, and must remain posted for 30 days.

There were no deficiencies cited in today's visit.
SUPERVISOR'S NAME: Zakiya AliTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2016
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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