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 observation, interview and record review, the licensee did not comply with the section cited above in 5 out of 5 children's files which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/09/2026

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101212(d)(1)(C) · 101212(d)(1)(C) Reporting Requirements (d) Upon the occurrence, during the operation of the child care center…a report shall be made to the Department by telephone… In addition, a written report shall be submitted to the Department within 10 working days (1) Events report shall include… (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. Director states they will submit a written declaration acknowledging that they have read, reviewed and understand the Reporting Requirements for California Code of Regulations, Title 22. Based on LPA's record reviews and interviews, five (5) interviewed staff confirmed of incident in which C1 wandered away from the classroom without adult’s supervision, and there was record of the incident being reported to C1’s representatives, however, facility did not report the incident to the Department, which posed a potential risk to the health, safety and personal rights to the children in care. Nguyen K Tran NAME OF LICENSING PROGRAM MANAGER Alma Castro NAME OF LICENSING PROGRAM ANALYST LICENSING PROGRAM ANALYST SIGNATURE DATE 01/06/2026 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

101170(d)(2) · 101170 Criminal Record Clearance: (d) All individuals subject to criminal record review shall, be fingerprinted...of perjury. (2) The licensee...prior to the individual's employment or initial presence in the child care facility.

Emily Mohr and Chloe Lin did not obtain Director immediately had Chloe Lin and Emily Mohr leave the premises and were sent to complete their finger prints. Director stated they will have Chloe and Emily return once criminal record clearances have been obtained. a criminal record clearances prior to their initial presence in the facility and have been working since 09/08/2023 and 10/27/2023. This is an immediate health and safety and personal rights risk to the children in care. Civil penalty of $1000 was assessed. SUPERVISOR'S NAME: Judy Hanson

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

101227(a)(7) · (B 101227(a)(7)(B) Food Service ...(B) A child shall not be served any food to which the child's record indicates he/she has an allergy.

evidenced by Based on LPA’s interview and record review Director reports she conducted an emergency meeting with staff and went over entire allergy protocol, reviewed allergy list provided in each class; and reviewed new protocol which required daily signature of all staff members present in classroom and director's signature at end of week; also the facility served an allergic item (wheat thins) to C #1 during snack time, and the Item was listed LIC 702 Child's Preadmission Health History-Parents Report which was received upon admission by the facility. This poses an immediate risk to Health and Safety to children in care. extended day care is now being provided in each child's specific classroom. Also any child requiring an epi pen must provide own snack. Director to provide plan, copy of sign in sheet for emergency meeting by

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.