GEORGE MAYNE STATE PS/CHILDREN CTR

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 11/22/2024 at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit. LPA met with the Director Maria De La Torre and explained the nature of the visit. Present on the facility were 2 Staff and 13 preschool children. The facility operates from Monday to Friday from 7:30 am to 5:30 pm. On 11/19/2024 at 9:44 am, the Director reported C1’s injury that happened in the facility via telephone at the Regional Office. On LPA Estoesta interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up, to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that C1's appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed with left elbow injury. LPA concluded that S1’s interference C1, resulted to C1’s injury. The Licensee is in violation for the section 101223 Personal Rights (a) 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, medication or aids to physical functioning. LPA Estoesta informed the Director, Maria De La Torre, that this report dated 11/22/2024 included a Type B Citation which can be posted as there is a potential risk to the health, safety, or personal rights of children in care. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director, Maria De La Torre. SUPERVISORS NAME: Jason Jang LICENSING EVALUATOR NAME: Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 2 FACILITY NAME: GEORGE MAYNE STATE PS/CHILDREN CTR FACILITY NUMBER: 430710434 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/22/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/13/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223 (a)(3) 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, medication or aids to physical functioning...... 1 2 3 4 5 6 7The Director will conduct a Staff Meeting that will focus on Personal Rights on 12/2/2024 and will submit a POC proof to the Regional Office. 8 9 10 11 12 13 14This requirement is not met as evidenced by, based on the LPA's interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed left elbow injury. LPA concluded that S1’s interference that resulted C1’s injury. This poses a potential risk to the health, safety or personal rights to children in care.8 9 10 11 12 13 14LPA Estoesta recommended to include the Children’s Personal Rights in Child Care video https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/, for the Staff Meeting. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Jang LICENSING EVALUATOR NAME:Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 11/22/2024 at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit. LPA met with the Director Maria De La Torre and explained the nature of the visit. Present on the facility were 2 Staff and 13 preschool children. The facility operates from Monday to Friday from 7:30 am to 5:30 pm. On 11/19/2024 at 9:44 am, the Director reported C1’s injury that happened in the facility via telephone at the Regional Office. On LPA Estoesta interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up, to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that C1's appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed with left elbow injury. LPA concluded that S1’s interference C1, resulted to C1’s injury. The Licensee is in violation for the section 101223 Personal Rights (a) 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, medication or aids to physical functioning. LPA Estoesta informed the Director, Maria De La Torre, that this report dated 11/22/2024 included a Type B Citation which can be posted as there is a potential risk to the health, safety, or personal rights of children in care. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director, Maria De La Torre. SUPERVISORS NAME: Jason Jang LICENSING EVALUATOR NAME: Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 2 FACILITY NAME: GEORGE MAYNE STATE PS/CHILDREN CTR FACILITY NUMBER: 430710434 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/22/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/13/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223 (a)(3) 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, medication or aids to physical functioning...... 1 2 3 4 5 6 7The Director will conduct a Staff Meeting that will focus on Personal Rights on 12/2/2024 and will submit a POC proof to the Regional Office. 8 9 10 11 12 13 14This requirement is not met as evidenced by, based on the LPA's interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed left elbow injury. LPA concluded that S1’s interference that resulted C1’s injury. This poses a potential risk to the health, safety or personal rights to children in care.8 9 10 11 12 13 14LPA Estoesta recommended to include the Children’s Personal Rights in Child Care video https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/, for the Staff Meeting. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Jang LICENSING EVALUATOR NAME:Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 11/22/2024 at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit. LPA met with the Director Maria De La Torre and explained the nature of the visit. Present on the facility were 2 Staff and 13 preschool children. The facility operates from Monday to Friday from 7:30 am to 5:30 pm. On 11/19/2024 at 9:44 am, the Director reported C1’s injury that happened in the facility via telephone at the Regional Office. On LPA Estoesta interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up, to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that C1's appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed with left elbow injury. LPA concluded that S1’s interference C1, resulted to C1’s injury. The Licensee is in violation for the section 101223 Personal Rights (a) 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, medication or aids to physical functioning. LPA Estoesta informed the Director, Maria De La Torre, that this report dated 11/22/2024 included a Type B Citation which can be posted as there is a potential risk to the health, safety, or personal rights of children in care. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director, Maria De La Torre. SUPERVISORS NAME: Jason Jang LICENSING EVALUATOR NAME: Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 2 FACILITY NAME: GEORGE MAYNE STATE PS/CHILDREN CTR FACILITY NUMBER: 430710434 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/22/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/13/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223 (a)(3) 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, medication or aids to physical functioning...... 1 2 3 4 5 6 7The Director will conduct a Staff Meeting that will focus on Personal Rights on 12/2/2024 and will submit a POC proof to the Regional Office. 8 9 10 11 12 13 14This requirement is not met as evidenced by, based on the LPA's interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed left elbow injury. LPA concluded that S1’s interference that resulted C1’s injury. This poses a potential risk to the health, safety or personal rights to children in care.8 9 10 11 12 13 14LPA Estoesta recommended to include the Children’s Personal Rights in Child Care video https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/, for the Staff Meeting. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Jang LICENSING EVALUATOR NAME:Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 11/22/2024 at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit. LPA met with the Director Maria De La Torre and explained the nature of the visit. Present on the facility were 2 Staff and 13 preschool children. The facility operates from Monday to Friday from 7:30 am to 5:30 pm. On 11/19/2024 at 9:44 am, the Director reported C1’s injury that happened in the facility via telephone at the Regional Office. On LPA Estoesta interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up, to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that C1's appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed with left elbow injury. LPA concluded that S1’s interference C1, resulted to C1’s injury. The Licensee is in violation for the section 101223 Personal Rights (a) 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, medication or aids to physical functioning. LPA Estoesta informed the Director, Maria De La Torre, that this report dated 11/22/2024 included a Type B Citation which can be posted as there is a potential risk to the health, safety, or personal rights of children in care. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director, Maria De La Torre. SUPERVISORS NAME: Jason Jang LICENSING EVALUATOR NAME: Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 2 FACILITY NAME: GEORGE MAYNE STATE PS/CHILDREN CTR FACILITY NUMBER: 430710434 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/22/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/13/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223 (a)(3) 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, medication or aids to physical functioning...... 1 2 3 4 5 6 7The Director will conduct a Staff Meeting that will focus on Personal Rights on 12/2/2024 and will submit a POC proof to the Regional Office. 8 9 10 11 12 13 14This requirement is not met as evidenced by, based on the LPA's interview, the incident happened on 11/18/2024 at 3:40 pm in Room F3, C1 was on the floor next to the bookshelves on the “Science Corner,” crying, S1 approached C1 and “pulled” and “picked” C1’s up to bring back to the group. C1 did not stop crying and when the Director assessed C1’s arm, it appeared that the left upper arm showed redness pattern on it. C1 pulled away her arm that appeared to be C1’s in pain. C1 was brought to an Emergency Room at 5:23 pm on the same day. C1 had history of nursemaid’s elbow. C1 was brought to another medical provider on 11/19/2024, due to pain on the arm and was diagnosed left elbow injury. LPA concluded that S1’s interference that resulted C1’s injury. This poses a potential risk to the health, safety or personal rights to children in care.8 9 10 11 12 13 14LPA Estoesta recommended to include the Children’s Personal Rights in Child Care video https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/, for the Staff Meeting. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Jang LICENSING EVALUATOR NAME:Manel Estoesta LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected