101212(d)(1)(C) · Reporting Requirements (d) Upon the occurrence...a report shall be made to the Department ...within the Department's next working day (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. Per Lead Teacher, they will submit an unusual incident report to the Department by POC date for the incident that took place on 10/08/25. A statement from staff and administration will be submitted stating they will immediately report a UIR that concerns Child #1.

Based on record review and interview, the licensee did not ensure that an incident on 09/30/25 was reported within 24 hrs, and an incident on 10/08/25, was not reported. This poses a potential risk to the health, safety, and personal rights of children in care. Ana Chico NAME OF LICENSING PROGRAM MANAGER: Nolan Tcheng NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/15/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.