FUSD/SHADOW HILLS ELEMENTARY

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

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 the date and time listed, Licensing Program Analyst (LPA) Eric Ramos arrived at the facility for the purposes of conducting a Case Management inspection in response to the receipt of an Unusual Incident Report (UIR) that was reported by the facility on 10/30/2025. LPA explained the purpose of today's inspection, completed a facility tour, and obtained a census. On 10/30/2025, it was reported by the facility that after breakfast time, staff took children in groups to the restroom located near the playground. Pertinent parties stated that a group of six children were returning from the restroom and entered the classroom. The children were then checked back in from the transition. Pertinent parties disclosed that about two minutes later, they heard knocking at the door. There was a staff member from the playground with a child from the classroom and the child was crying. It was disclosed that the child was left alone in the restroom and was attempting to get into the classroom by knocking, but was not heard until the staff member saw the child and assisted the child. Based on information obtained during the investigation, it has been determined there is a violation of Title 22 Regulations pertaining to the reported incident. See LIC809-D for cited deficiency. 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 Eman Metri. NAME OF LICENSING PROGRAM MANAGER: Ana Noble NAME OF LICENSING PROGRAM ANALYST: Eric Ramos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/04/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2025 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 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 issue a Penalty Notice, when applicable, to all facilities holding a license issued by th

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 the date and time listed, Licensing Program Analyst (LPA) Eric Ramos arrived at the facility for the purposes of conducting a Case Management inspection in response to the receipt of an Unusual Incident Report (UIR) that was reported by the facility on 10/30/2025. LPA explained the purpose of today's inspection, completed a facility tour, and obtained a census. On 10/30/2025, it was reported by the facility that after breakfast time, staff took children in groups to the restroom located near the playground. Pertinent parties stated that a group of six children were returning from the restroom and entered the classroom. The children were then checked back in from the transition. Pertinent parties disclosed that about two minutes later, they heard knocking at the door. There was a staff member from the playground with a child from the classroom and the child was crying. It was disclosed that the child was left alone in the restroom and was attempting to get into the classroom by knocking, but was not heard until the staff member saw the child and assisted the child. Based on information obtained during the investigation, it has been determined there is a violation of Title 22 Regulations pertaining to the reported incident. See LIC809-D for cited deficiency. 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 Eman Metri. NAME OF LICENSING PROGRAM MANAGER: Ana Noble NAME OF LICENSING PROGRAM ANALYST: Eric Ramos LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/04/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2025 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 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 issue a Penalty Notice, when applicable, to all facilities holding a license issued by th