POTRERO CANYON SCHOOL LLC

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Andrea Cortez and Licensing Program Manager (LPM) Gladys Kuizon conducted an unannounced Case Management Inspection at the facility today and met with Director Andra Briant . LPA and LPM arrived 10:17AM and observed 4 staff and 21 children. The purpose of today's visit is to investigate an incident that occurred on 02-13-2024. Facility self reported an incident 02-13-2024 where child (C1) was left unattended in room 1 for 5-7 minutes. C1 was in a secured room sitting in the corner until found by staff. C1 was not injured during this incident. LPA and LPM interviewed Director. Director stated staff training was completed and an Individual Development Plan was completed and discussed with staff (S1). A Notice of Site Visit has been issued and must remain posted for 30 consecutive days. A Deficiency has been cited as a result of today's inspection. Please refer to page 809-D for citation, description, and plan of correction. LPA discussed the requirements of AB633 to Director Andra Briant and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). Exit interview conducted with Director Andra where this report was reviewed and a copy of appeal rights was provided. SUPERVISORS NAME: Gladys Kuizon LICENSING EVALUATOR NAME: Andrea Cortez LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024 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: POTRERO CANYON SCHOOL LLC FACILITY NUMBER: 274416181 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/02/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type A 04/03/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7Care and Supervision No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).1 2 3 4 5 6 7Written plan of action completed on 2-16-2024 and reviewed today. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on written report and interview with Director, C1 was left unattended in Room 1 on 02-13-24. This poses an immediate safety risk to C1.8 9 10 11 12 13 14 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:Gladys Kuizon LICENSING EVALUATOR NAME:Andrea Cortez LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Andrea Cortez and Licensing Program Manager (LPM) Gladys Kuizon conducted an unannounced Case Management Inspection at the facility today and met with Director Andra Briant . LPA and LPM arrived 10:17AM and observed 4 staff and 21 children. The purpose of today's visit is to investigate an incident that occurred on 02-13-2024. Facility self reported an incident 02-13-2024 where child (C1) was left unattended in room 1 for 5-7 minutes. C1 was in a secured room sitting in the corner until found by staff. C1 was not injured during this incident. LPA and LPM interviewed Director. Director stated staff training was completed and an Individual Development Plan was completed and discussed with staff (S1). A Notice of Site Visit has been issued and must remain posted for 30 consecutive days. A Deficiency has been cited as a result of today's inspection. Please refer to page 809-D for citation, description, and plan of correction. LPA discussed the requirements of AB633 to Director Andra Briant and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). Exit interview conducted with Director Andra where this report was reviewed and a copy of appeal rights was provided. SUPERVISORS NAME: Gladys Kuizon LICENSING EVALUATOR NAME: Andrea Cortez LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024 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: POTRERO CANYON SCHOOL LLC FACILITY NUMBER: 274416181 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/02/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type A 04/03/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7Care and Supervision No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).1 2 3 4 5 6 7Written plan of action completed on 2-16-2024 and reviewed today. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on written report and interview with Director, C1 was left unattended in Room 1 on 02-13-24. This poses an immediate safety risk to C1.8 9 10 11 12 13 14 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:Gladys Kuizon LICENSING EVALUATOR NAME:Andrea Cortez LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024

Type A citation - immediate risk to health, safety, or personal rights