Christ The King Lutheran Preschool

101229(a)(1) · No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation This requirement has not been met as ecidenced by DIrector will hold a staff training on 10/13/25 regarding care and supervision and disaster drill procedures. Director will provide LPA with training materials, meeting attendance roster, and disaster plan procedures via email by 10/17/25.

Based on interviews and record review, C1 was left unattended in a classroom for approximately 5-7 minutes, therefore the licensee did not comply with the section cited above in which posed a potential health, safety or personal rights risk to persons in care Carlos Martinez NAME OF LICENSING PROGRAM MANAGER: Kelli Waters NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

101221(b)(8)(C) · Child's Records (C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f).

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 6 persons mising LIC627 in files which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/26/2024

101223(b)(1) · Personal Rights (1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 6 persons mising LIC613A which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/26/2024

101212(d) · Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. Director agrees to submit a plan of correction on how the facility will handle notifying parents and CCL when an incident takes place during operation hours. Director will submit POC to LPA via email by 5/31/24. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This was not met as evidenced by,

based on interviews parents and CCL were not notified that school went on lockdown. This is a potential health and safety risk to the children in care

101226(e)(2) · Health-Related Services (2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 4 persons had an epi pen on file with no prescription label which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 11/03/2023

101226(e)(3)(B) · Health-Related Services (3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 4 persons which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 11/03/2023

101174(d)(2) · Disaster and Mass Casualty Plan (d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that there has not been a disaster drill completed in the last 6 months which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/13/2023

101216(g)(2) · Personnel Requirements (2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 11/03/2023

101216.1(c)(1) · Teacher Qualifications and Duties (c) To be a fully qualified teacher, a teacher shall have one of the following: (1) Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 3 persons were left alone in a classroom that were not fully qualified teachers which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 11/03/2023

101216.2(e) · Teacher Aide Qualifications and Duties - An aide shall work only under the direct supervision of a teacher.

as LPA observed a Teacher's Aide working alone with seven children on the playground without a qualified teacher being present. This is a potential risk to the health and Director, Angela Costa agrees to submit in writing to Community Care LIcensing on how to prevent this from occurring in the future. of safety of children in care.