DAVIS PARENT NURSERY SCHOOL #2

Type A citation from complaint investigation - immediate risk

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 26 27 28 29 30 31 32An exit interview was conducted, and the report was reviewed with the Director, Becky Montgomery. LPA provided the Director with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024 FACILITY NAME: DAVIS PARENT NURSERY SCHOOL #2FACILITY NUMBER: 570310219 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 05/31/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 06/03/2024 Section Cited CCR 101229(a)(1)1 2 3 4 5 6 7101229 Responsibility for Providing Care and Supervision (a)...shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, ...Supervision shall include visual observation.1 2 3 4 5 6 7Director will conduct a training on supervision to staff members and have all staff members sign a form stating that they understand the training. Director will send LPA signatures by due date. 8 9 10 11 12 13 14This regulation was not met as evidenced by:Based on interviews, LPA learned of an incident where Child 1 and Child 2 were left unsupervised in the bathroom which resulted in inappropriate touching which poses an immediate health, safety, or personal rights risk to children in care.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. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024

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 26 27 28 29 30 31 32An exit interview was conducted, and the report was reviewed with the Director, Becky Montgomery. LPA provided the Director with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024 FACILITY NAME: DAVIS PARENT NURSERY SCHOOL #2FACILITY NUMBER: 570310219 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 05/31/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 06/03/2024 Section Cited CCR 101229(a)(1)1 2 3 4 5 6 7101229 Responsibility for Providing Care and Supervision (a)...shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, ...Supervision shall include visual observation.1 2 3 4 5 6 7Director will conduct a training on supervision to staff members and have all staff members sign a form stating that they understand the training. Director will send LPA signatures by due date. 8 9 10 11 12 13 14This regulation was not met as evidenced by:Based on interviews, LPA learned of an incident where Child 1 and Child 2 were left unsupervised in the bathroom which resulted in inappropriate touching which poses an immediate health, safety, or personal rights risk to children in care.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. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32An exit interview was conducted, and the report was reviewed with the Director, Becky Montgomery. LPA provided the Director with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024 FACILITY NAME: DAVIS PARENT NURSERY SCHOOL #2FACILITY NUMBER: 570310219 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 05/31/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 06/03/2024 Section Cited CCR 101229(a)(1)1 2 3 4 5 6 7101229 Responsibility for Providing Care and Supervision (a)...shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, ...Supervision shall include visual observation.1 2 3 4 5 6 7Director will conduct a training on supervision to staff members and have all staff members sign a form stating that they understand the training. Director will send LPA signatures by due date. 8 9 10 11 12 13 14This regulation was not met as evidenced by:Based on interviews, LPA learned of an incident where Child 1 and Child 2 were left unsupervised in the bathroom which resulted in inappropriate touching which poses an immediate health, safety, or personal rights risk to children in care.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. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32An exit interview was conducted, and the report was reviewed with the Director, Becky Montgomery. LPA provided the Director with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024 FACILITY NAME: DAVIS PARENT NURSERY SCHOOL #2FACILITY NUMBER: 570310219 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 05/31/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 06/03/2024 Section Cited CCR 101229(a)(1)1 2 3 4 5 6 7101229 Responsibility for Providing Care and Supervision (a)...shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, ...Supervision shall include visual observation.1 2 3 4 5 6 7Director will conduct a training on supervision to staff members and have all staff members sign a form stating that they understand the training. Director will send LPA signatures by due date. 8 9 10 11 12 13 14This regulation was not met as evidenced by:Based on interviews, LPA learned of an incident where Child 1 and Child 2 were left unsupervised in the bathroom which resulted in inappropriate touching which poses an immediate health, safety, or personal rights risk to children in care.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. SUPERVISORS NAME: Karyn Guerra LICENSING EVALUATOR NAME: Jennie Tedlos LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024

Type B citation - potential risk if not corrected