CENTER FOR CHILD & FAMILY STUDIES

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

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

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 25Licensing Program Analyst (LPA) Jennie Tedlos with Director, Kelly Twibell, to follow up on an Unusual Incident Report (UIR) that occurred on 12/08/25. There were no children's present during today's visit to the facility. The facility reported the UIR to Community Care Licensing within 24hrs and provided the required written UIR describing the specifics of the incident within 7 days. On 12/08/25, a child (C1) with an egg allergy was served a waffle, which was with eggs, by a teacher's assistant (TA). There was a prepared lunch serving for C1 that did not include egg and a food alert card placed on C1's tray. However the TA did not see C1's food alert card and mistakenly served C1 a waffle that was made with egg, which C1 took one bite of. C1's parents did not provide an allergy medication to the facility. C1's parents were contacted immediately and paramedics were called out of precaution. After parent and paramedic observation and intervention, C1 remained at the facility for the rest of the school day. Immediately following the incident, corrective actions have taken place which includes staff training on serving meals to children with allergies as well as new red trays for meals to be served on for children with allergies. Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report, dated 12/16/25, documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with Director, Kelly Twibell. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Appeal rights were provided. NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025 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 3 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

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) Jennie Tedlos with Director, Kelly Twibell, to follow up on an Unusual Incident Report (UIR) that occurred on 12/08/25. There were no children's present during today's visit to the facility. The facility reported the UIR to Community Care Licensing within 24hrs and provided the required written UIR describing the specifics of the incident within 7 days. On 12/08/25, a child (C1) with an egg allergy was served a waffle, which was with eggs, by a teacher's assistant (TA). There was a prepared lunch serving for C1 that did not include egg and a food alert card placed on C1's tray. However the TA did not see C1's food alert card and mistakenly served C1 a waffle that was made with egg, which C1 took one bite of. C1's parents did not provide an allergy medication to the facility. C1's parents were contacted immediately and paramedics were called out of precaution. After parent and paramedic observation and intervention, C1 remained at the facility for the rest of the school day. Immediately following the incident, corrective actions have taken place which includes staff training on serving meals to children with allergies as well as new red trays for meals to be served on for children with allergies. Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report, dated 12/16/25, documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with Director, Kelly Twibell. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Appeal rights were provided. NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025 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 3 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

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) Jennie Tedlos with Director, Kelly Twibell, to follow up on an Unusual Incident Report (UIR) that occurred on 12/08/25. There were no children's present during today's visit to the facility. The facility reported the UIR to Community Care Licensing within 24hrs and provided the required written UIR describing the specifics of the incident within 7 days. On 12/08/25, a child (C1) with an egg allergy was served a waffle, which was with eggs, by a teacher's assistant (TA). There was a prepared lunch serving for C1 that did not include egg and a food alert card placed on C1's tray. However the TA did not see C1's food alert card and mistakenly served C1 a waffle that was made with egg, which C1 took one bite of. C1's parents did not provide an allergy medication to the facility. C1's parents were contacted immediately and paramedics were called out of precaution. After parent and paramedic observation and intervention, C1 remained at the facility for the rest of the school day. Immediately following the incident, corrective actions have taken place which includes staff training on serving meals to children with allergies as well as new red trays for meals to be served on for children with allergies. Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report, dated 12/16/25, documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with Director, Kelly Twibell. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Appeal rights were provided. NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025 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 3 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

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) Jennie Tedlos with Director, Kelly Twibell, to follow up on an Unusual Incident Report (UIR) that occurred on 12/08/25. There were no children's present during today's visit to the facility. The facility reported the UIR to Community Care Licensing within 24hrs and provided the required written UIR describing the specifics of the incident within 7 days. On 12/08/25, a child (C1) with an egg allergy was served a waffle, which was with eggs, by a teacher's assistant (TA). There was a prepared lunch serving for C1 that did not include egg and a food alert card placed on C1's tray. However the TA did not see C1's food alert card and mistakenly served C1 a waffle that was made with egg, which C1 took one bite of. C1's parents did not provide an allergy medication to the facility. C1's parents were contacted immediately and paramedics were called out of precaution. After parent and paramedic observation and intervention, C1 remained at the facility for the rest of the school day. Immediately following the incident, corrective actions have taken place which includes staff training on serving meals to children with allergies as well as new red trays for meals to be served on for children with allergies. Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report, dated 12/16/25, documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with Director, Kelly Twibell. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Appeal rights were provided. NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025 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 3 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

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) Jennie Tedlos with Director, Kelly Twibell, to follow up on an Unusual Incident Report (UIR) that occurred on 12/08/25. There were no children's present during today's visit to the facility. The facility reported the UIR to Community Care Licensing within 24hrs and provided the required written UIR describing the specifics of the incident within 7 days. On 12/08/25, a child (C1) with an egg allergy was served a waffle, which was with eggs, by a teacher's assistant (TA). There was a prepared lunch serving for C1 that did not include egg and a food alert card placed on C1's tray. However the TA did not see C1's food alert card and mistakenly served C1 a waffle that was made with egg, which C1 took one bite of. C1's parents did not provide an allergy medication to the facility. C1's parents were contacted immediately and paramedics were called out of precaution. After parent and paramedic observation and intervention, C1 remained at the facility for the rest of the school day. Immediately following the incident, corrective actions have taken place which includes staff training on serving meals to children with allergies as well as new red trays for meals to be served on for children with allergies. Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report, dated 12/16/25, documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with Director, Kelly Twibell. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Appeal rights were provided. NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025 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 3 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

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) Jennie Tedlos with Director, Kelly Twibell, to follow up on an Unusual Incident Report (UIR) that occurred on 12/08/25. There were no children's present during today's visit to the facility. The facility reported the UIR to Community Care Licensing within 24hrs and provided the required written UIR describing the specifics of the incident within 7 days. On 12/08/25, a child (C1) with an egg allergy was served a waffle, which was with eggs, by a teacher's assistant (TA). There was a prepared lunch serving for C1 that did not include egg and a food alert card placed on C1's tray. However the TA did not see C1's food alert card and mistakenly served C1 a waffle that was made with egg, which C1 took one bite of. C1's parents did not provide an allergy medication to the facility. C1's parents were contacted immediately and paramedics were called out of precaution. After parent and paramedic observation and intervention, C1 remained at the facility for the rest of the school day. Immediately following the incident, corrective actions have taken place which includes staff training on serving meals to children with allergies as well as new red trays for meals to be served on for children with allergies. Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report, dated 12/16/25, documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with Director, Kelly Twibell. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Appeal rights were provided. NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025 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 3 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