CHRIST LUTHERAN PRESCHOOL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25(Page 1) Licensing program analysts (LPAs) Giselle Lucero and Kathy Trinh conducted a Case Management visit, on today's date 04/29/2025. The purpose of today's visit is due to deficiencies that were observed during an unusual incident report (UIR) that was reported by the facility on 04/09/2025. The facility reported the ratio on the date of the incident to be 13 toddlers to 3 staff in Room #107. It was observed the facility is currently licensed for a capacity of 7 toddlers in the “New Nursey/Pink Room #117” only. LPAs met with Director Emily Martinez. Upon arrival LPAs toured the facility and census was taken. LPAs observed 12 toddler children with 3 staff in the Toddler room/Room #107 and a total of 96 preschool children with 12 staff in the play yard and classrooms (Orange Stars/Room#116, Purple Stars/Room #108, Red Stars/Room# 109, Blue Stars/Room #110, Yellow Stars/ Room#115, Green Stars/ Room #111). A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During interview with Director, Director stated Room #107 had been previously licensed under the preschool license and they were previously licensed for 12 toddler children. Director was unaware a fire clearance approval, and the Department’s approval is needed to be obtained for toddler usage in Yellow Stars/Room #107 before moving the toddler class in that room and was unaware of the decrease in the toddler capacity. (continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Martha Malane NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025 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 5 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to is

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25(Page 1) Licensing program analysts (LPAs) Giselle Lucero and Kathy Trinh conducted a Case Management visit, on today's date 04/29/2025. The purpose of today's visit is due to deficiencies that were observed during an unusual incident report (UIR) that was reported by the facility on 04/09/2025. The facility reported the ratio on the date of the incident to be 13 toddlers to 3 staff in Room #107. It was observed the facility is currently licensed for a capacity of 7 toddlers in the “New Nursey/Pink Room #117” only. LPAs met with Director Emily Martinez. Upon arrival LPAs toured the facility and census was taken. LPAs observed 12 toddler children with 3 staff in the Toddler room/Room #107 and a total of 96 preschool children with 12 staff in the play yard and classrooms (Orange Stars/Room#116, Purple Stars/Room #108, Red Stars/Room# 109, Blue Stars/Room #110, Yellow Stars/ Room#115, Green Stars/ Room #111). A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During interview with Director, Director stated Room #107 had been previously licensed under the preschool license and they were previously licensed for 12 toddler children. Director was unaware a fire clearance approval, and the Department’s approval is needed to be obtained for toddler usage in Yellow Stars/Room #107 before moving the toddler class in that room and was unaware of the decrease in the toddler capacity. (continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Martha Malane NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025 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 5 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to is

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25(Page 1) Licensing program analysts (LPAs) Giselle Lucero and Kathy Trinh conducted a Case Management visit, on today's date 04/29/2025. The purpose of today's visit is due to deficiencies that were observed during an unusual incident report (UIR) that was reported by the facility on 04/09/2025. The facility reported the ratio on the date of the incident to be 13 toddlers to 3 staff in Room #107. It was observed the facility is currently licensed for a capacity of 7 toddlers in the “New Nursey/Pink Room #117” only. LPAs met with Director Emily Martinez. Upon arrival LPAs toured the facility and census was taken. LPAs observed 12 toddler children with 3 staff in the Toddler room/Room #107 and a total of 96 preschool children with 12 staff in the play yard and classrooms (Orange Stars/Room#116, Purple Stars/Room #108, Red Stars/Room# 109, Blue Stars/Room #110, Yellow Stars/ Room#115, Green Stars/ Room #111). A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During interview with Director, Director stated Room #107 had been previously licensed under the preschool license and they were previously licensed for 12 toddler children. Director was unaware a fire clearance approval, and the Department’s approval is needed to be obtained for toddler usage in Yellow Stars/Room #107 before moving the toddler class in that room and was unaware of the decrease in the toddler capacity. (continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Martha Malane NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025 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 5 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to is

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25(Page 1) Licensing program analysts (LPAs) Giselle Lucero and Kathy Trinh conducted a Case Management visit, on today's date 04/29/2025. The purpose of today's visit is due to deficiencies that were observed during an unusual incident report (UIR) that was reported by the facility on 04/09/2025. The facility reported the ratio on the date of the incident to be 13 toddlers to 3 staff in Room #107. It was observed the facility is currently licensed for a capacity of 7 toddlers in the “New Nursey/Pink Room #117” only. LPAs met with Director Emily Martinez. Upon arrival LPAs toured the facility and census was taken. LPAs observed 12 toddler children with 3 staff in the Toddler room/Room #107 and a total of 96 preschool children with 12 staff in the play yard and classrooms (Orange Stars/Room#116, Purple Stars/Room #108, Red Stars/Room# 109, Blue Stars/Room #110, Yellow Stars/ Room#115, Green Stars/ Room #111). A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During interview with Director, Director stated Room #107 had been previously licensed under the preschool license and they were previously licensed for 12 toddler children. Director was unaware a fire clearance approval, and the Department’s approval is needed to be obtained for toddler usage in Yellow Stars/Room #107 before moving the toddler class in that room and was unaware of the decrease in the toddler capacity. (continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Martha Malane NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025 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 5 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to is

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

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25(Page 1) Licensing program analysts (LPAs) Giselle Lucero and Kathy Trinh conducted a Case Management visit, on today's date 04/29/2025. The purpose of today's visit is due to deficiencies that were observed during an unusual incident report (UIR) that was reported by the facility on 04/09/2025. The facility reported the ratio on the date of the incident to be 13 toddlers to 3 staff in Room #107. It was observed the facility is currently licensed for a capacity of 7 toddlers in the “New Nursey/Pink Room #117” only. LPAs met with Director Emily Martinez. Upon arrival LPAs toured the facility and census was taken. LPAs observed 12 toddler children with 3 staff in the Toddler room/Room #107 and a total of 96 preschool children with 12 staff in the play yard and classrooms (Orange Stars/Room#116, Purple Stars/Room #108, Red Stars/Room# 109, Blue Stars/Room #110, Yellow Stars/ Room#115, Green Stars/ Room #111). A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During interview with Director, Director stated Room #107 had been previously licensed under the preschool license and they were previously licensed for 12 toddler children. Director was unaware a fire clearance approval, and the Department’s approval is needed to be obtained for toddler usage in Yellow Stars/Room #107 before moving the toddler class in that room and was unaware of the decrease in the toddler capacity. (continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Martha Malane NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025 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 5 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to is

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25(Page 1) Licensing program analysts (LPAs) Giselle Lucero and Kathy Trinh conducted a Case Management visit, on today's date 04/29/2025. The purpose of today's visit is due to deficiencies that were observed during an unusual incident report (UIR) that was reported by the facility on 04/09/2025. The facility reported the ratio on the date of the incident to be 13 toddlers to 3 staff in Room #107. It was observed the facility is currently licensed for a capacity of 7 toddlers in the “New Nursey/Pink Room #117” only. LPAs met with Director Emily Martinez. Upon arrival LPAs toured the facility and census was taken. LPAs observed 12 toddler children with 3 staff in the Toddler room/Room #107 and a total of 96 preschool children with 12 staff in the play yard and classrooms (Orange Stars/Room#116, Purple Stars/Room #108, Red Stars/Room# 109, Blue Stars/Room #110, Yellow Stars/ Room#115, Green Stars/ Room #111). A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During interview with Director, Director stated Room #107 had been previously licensed under the preschool license and they were previously licensed for 12 toddler children. Director was unaware a fire clearance approval, and the Department’s approval is needed to be obtained for toddler usage in Yellow Stars/Room #107 before moving the toddler class in that room and was unaware of the decrease in the toddler capacity. (continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Martha Malane NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025 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 5 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to is

Type B citation from complaint investigation - potential risk if not corrected