Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364815634
Report Date: 09/21/2017
Date Signed 09/22/2017 10:54:32 AM

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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
364815634
ADMINISTRATOR:THERESA SALLEYFACILITY TYPE:
830
ADDRESS:620 BASELINE ROADTELEPHONE:
(909) 874-5113
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:8CENSUS: 6DATE:
09/21/2017
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Theresa SalleyTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a Case Management visit for a reason unrelated to the Infant Program. However, in touring the facility LPA Lopez observed 6 infants and only 1 staff supervising them.

This is a violation of the following regulation section:
101416.5 (b) Staff-Infant Ratio - There shall be a ratio of one teacher for every four infants in attendance.

See LIC 809-D for cited deficiency.

An exit interview was conducted with Director Theresa Salley. A copy of this report and appeal rights were issued and discussed.

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC809D) CITED DURING THIS INSPECTION. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.

This report must be available for review, upon request, for the next 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 782-4116
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2017
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 364815634
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/22/2017
Section Cited
CCR
101416.5(b)
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Staff-Infant Ratio - There shall be a ratio of one teacher for every four infants in attendance. While touring the facility for the purpose of obtaining a census, LPA Lopez observed 6 infants and only 1 staff supervising them.
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Additional staff arrived minutes later in order to meet ratios. Director agrees to submit a plan that will be implemented in order to avoid being out of ratio. Part of the plan shall include a schedule to assure proper staffing. Plan to be submitted to the Department by 9/22/17.
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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: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 782-4116
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2017
LIC809 (FAS) - (06/04)
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