FREMONT PARENTS NURSERY SCHOOL

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 October 23, 2024 Licensing Program Analyst (LPA) Randy Miranda met with Director Stacy Gohman, for the purpose of an Unannounced Case Management Visit. The facility self reported on 10/08/2024 and a copy of the Unusual Incident Report (UIR) was reviewed by LPA. Per the report, Child 1 (C1) was found by his parents, unsupervised in the building for at least one minute. As a result, there was Lack of Supervision - one child was left inside the classroom without supervision. Although the facility states that the child was left inside alone for one minute, Title 22 Regulations 101229 (a)(1) states that no children shall be left without the supervision of a teacher at any time including visual supervision. The facility will be cited a Type A citation. Please see LIC 809D. The facility must post this report for thirty days. The facility must give each parent of the children in care and future parents of newly enrolled children, for the next twelve(12) months, a copy of this report. Parents are to sign an LIC 9224 – Acknowledgement of Receipt of Licensing Reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility. This report must remain on file for three years. Notice of site visit was provided and must be posted for 30 days. Appeal Rights provided. Exit interview conducted and reviewed with Director Stacy Gohman. SUPERVISORS NAME: Wynn Norona LICENSING EVALUATOR NAME: Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024 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: FREMONT PARENTS NURSERY SCHOOL FACILITY NUMBER: 013417033 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/23/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 10/23/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7(a) The licensee 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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: 1 2 3 4 5 6 7The facility will submit a Plan of Correction in writing by indicating how they will ensure that children are always directly supervised. Staff will also watch a video on Supervision on CCLD website. A copy of the summary of the training and a roster of staff who attended the training will be sent to LPA by two weeks. 8 9 10 11 12 13 14Based on self reported Unusual Incident Report, interview, and record review the facility did not ensure children were accounted for during 1 minute, which poses an immediate risk to the health and safety of 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. SUPERVISOR'S NAME:Wynn Norona LICENSING EVALUATOR NAME:Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024

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 25On October 23, 2024 Licensing Program Analyst (LPA) Randy Miranda met with Director Stacy Gohman, for the purpose of an Unannounced Case Management Visit. The facility self reported on 10/08/2024 and a copy of the Unusual Incident Report (UIR) was reviewed by LPA. Per the report, Child 1 (C1) was found by his parents, unsupervised in the building for at least one minute. As a result, there was Lack of Supervision - one child was left inside the classroom without supervision. Although the facility states that the child was left inside alone for one minute, Title 22 Regulations 101229 (a)(1) states that no children shall be left without the supervision of a teacher at any time including visual supervision. The facility will be cited a Type A citation. Please see LIC 809D. The facility must post this report for thirty days. The facility must give each parent of the children in care and future parents of newly enrolled children, for the next twelve(12) months, a copy of this report. Parents are to sign an LIC 9224 – Acknowledgement of Receipt of Licensing Reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility. This report must remain on file for three years. Notice of site visit was provided and must be posted for 30 days. Appeal Rights provided. Exit interview conducted and reviewed with Director Stacy Gohman. SUPERVISORS NAME: Wynn Norona LICENSING EVALUATOR NAME: Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024 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: FREMONT PARENTS NURSERY SCHOOL FACILITY NUMBER: 013417033 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/23/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 10/23/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7(a) The licensee 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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: 1 2 3 4 5 6 7The facility will submit a Plan of Correction in writing by indicating how they will ensure that children are always directly supervised. Staff will also watch a video on Supervision on CCLD website. A copy of the summary of the training and a roster of staff who attended the training will be sent to LPA by two weeks. 8 9 10 11 12 13 14Based on self reported Unusual Incident Report, interview, and record review the facility did not ensure children were accounted for during 1 minute, which poses an immediate risk to the health and safety of 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. SUPERVISOR'S NAME:Wynn Norona LICENSING EVALUATOR NAME:Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On October 23, 2024 Licensing Program Analyst (LPA) Randy Miranda met with Director Stacy Gohman, for the purpose of an Unannounced Case Management Visit. The facility self reported on 10/08/2024 and a copy of the Unusual Incident Report (UIR) was reviewed by LPA. Per the report, Child 1 (C1) was found by his parents, unsupervised in the building for at least one minute. As a result, there was Lack of Supervision - one child was left inside the classroom without supervision. Although the facility states that the child was left inside alone for one minute, Title 22 Regulations 101229 (a)(1) states that no children shall be left without the supervision of a teacher at any time including visual supervision. The facility will be cited a Type A citation. Please see LIC 809D. The facility must post this report for thirty days. The facility must give each parent of the children in care and future parents of newly enrolled children, for the next twelve(12) months, a copy of this report. Parents are to sign an LIC 9224 – Acknowledgement of Receipt of Licensing Reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility. This report must remain on file for three years. Notice of site visit was provided and must be posted for 30 days. Appeal Rights provided. Exit interview conducted and reviewed with Director Stacy Gohman. SUPERVISORS NAME: Wynn Norona LICENSING EVALUATOR NAME: Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024 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: FREMONT PARENTS NURSERY SCHOOL FACILITY NUMBER: 013417033 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/23/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 10/23/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7(a) The licensee 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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: 1 2 3 4 5 6 7The facility will submit a Plan of Correction in writing by indicating how they will ensure that children are always directly supervised. Staff will also watch a video on Supervision on CCLD website. A copy of the summary of the training and a roster of staff who attended the training will be sent to LPA by two weeks. 8 9 10 11 12 13 14Based on self reported Unusual Incident Report, interview, and record review the facility did not ensure children were accounted for during 1 minute, which poses an immediate risk to the health and safety of 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. SUPERVISOR'S NAME:Wynn Norona LICENSING EVALUATOR NAME:Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On October 23, 2024 Licensing Program Analyst (LPA) Randy Miranda met with Director Stacy Gohman, for the purpose of an Unannounced Case Management Visit. The facility self reported on 10/08/2024 and a copy of the Unusual Incident Report (UIR) was reviewed by LPA. Per the report, Child 1 (C1) was found by his parents, unsupervised in the building for at least one minute. As a result, there was Lack of Supervision - one child was left inside the classroom without supervision. Although the facility states that the child was left inside alone for one minute, Title 22 Regulations 101229 (a)(1) states that no children shall be left without the supervision of a teacher at any time including visual supervision. The facility will be cited a Type A citation. Please see LIC 809D. The facility must post this report for thirty days. The facility must give each parent of the children in care and future parents of newly enrolled children, for the next twelve(12) months, a copy of this report. Parents are to sign an LIC 9224 – Acknowledgement of Receipt of Licensing Reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility. This report must remain on file for three years. Notice of site visit was provided and must be posted for 30 days. Appeal Rights provided. Exit interview conducted and reviewed with Director Stacy Gohman. SUPERVISORS NAME: Wynn Norona LICENSING EVALUATOR NAME: Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024 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: FREMONT PARENTS NURSERY SCHOOL FACILITY NUMBER: 013417033 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/23/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 10/23/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7(a) The licensee 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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: 1 2 3 4 5 6 7The facility will submit a Plan of Correction in writing by indicating how they will ensure that children are always directly supervised. Staff will also watch a video on Supervision on CCLD website. A copy of the summary of the training and a roster of staff who attended the training will be sent to LPA by two weeks. 8 9 10 11 12 13 14Based on self reported Unusual Incident Report, interview, and record review the facility did not ensure children were accounted for during 1 minute, which poses an immediate risk to the health and safety of 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. SUPERVISOR'S NAME:Wynn Norona LICENSING EVALUATOR NAME:Randy Miranda LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024