101229(a)(1) · Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

as Executive Director will have an all staff meeting with staff reviewing the supervision policy and zoning. Executive director will submit agenda and sign in sheets of staff who attended by POC date (07/07/2025). evidence by: Based on interviews conducted, S1 was notified of the incident by P1. S1 informed S2 who was on the yard with children on the incident and was unaware the incident had occurred. This poses an immediate health and safety risk to children in care. Ana Chico NAME OF LICENSING PROGRAM MANAGER: Monique Jessica Ayala NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/24/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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... This requirement Executive director will review Reporting Requirement regulation and will forward any unusal incidents as directed by Ttitle 22 in the future. was not met as evidence by: Based on record reivew, the incident occurred on 06/16/2025 and was not reported to the department until 06/20/2025. This poses a potential health and safety risk for children in care. Ana Chico NAME OF LICENSING PROGRAM MANAGER Monique Jessica Ayala NAME OF LICENSING PROGRAM ANALYST LICENSING PROGRAM ANALYST SIGNATURE DATE 06/24/2025 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.

101216(l)(1)(B) · Personnel Requirements (B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 5 staff members does not have a signed LIC9052 which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 12/06/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101216(g)(1) · Personnel Requirements (1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 5 staff do not have a health screening or TB on file which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 12/20/2024

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

101238(a) · Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the sink in classroom to be in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 12/20/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101238.2(d)(2) · Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in a tire located in Sandbox yard was observed to be in disrepair and exposing the inside of the tire which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 12/20/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101223(a)(3) · Personal Rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to:interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, POC corrected: After all parties interviewed and Church and School Board and Legal team consulted during administrative review of incident: Staff involved was placed on administrative leave on 10/2/2021 and was subsequently dismissed on 10/8/21. medication or aids to physical functioning.

UIR 10/1/21 and LPA's follow up interviews with Director and witnessing/reporting staff who made Administration aware of a child's personal rights possibly being violated while in care SUPERVISOR'S NAME: Ana Chico

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.