GILROY UNIFIED SCHOOL DISTRICT ROD KELLEY PRE.

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 10/22/2025, Licensing Program Analyst (LPA) Liridon Fici- Doni conducted an unannounced case management visit for an incident that occurred on 10/3/2025. LPA was greeted by staff- Carolina La Ra Mendoza and informed her the purpose of visit. Shortly after, at 9:45AM, Beatrice Magdaleno, Early Childhood Administrator (ECA) arrived and met with LPA. LPA took a census of children present. During todays visit, LPA conducted interviews with staff. Based on interviews, LPA was informed by Staff 2- S2 that Staff 1- S1 initially kicked Child 1- C1 on 10/1/2025 and did not mention anything because S2 thought it was an accident. On 10/3/2025, both S2 and Staff 3- S3 witnessed S1 kick C1 on the foot and S2 and S3 both confirmed the incident. After C1 was kicked, S3 moved C1 away from S1 to avoid being kicked again. On 10/6/2025, C1 was sitting next to S1 and S2 witnessed S1 kick C1 twice and S2 informed the ECA about the incident. Staff stated C1 did not cry nor acknowledge being kicked. ECA conducted an investigation dated from 10/6/25 through 10/8/25. The following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the ECA, Beatrice Magdaleno. NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon NAME OF LICENSING PROGRAM ANALYST: Liridon Fici LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2025 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

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 10/22/2025, Licensing Program Analyst (LPA) Liridon Fici- Doni conducted an unannounced case management visit for an incident that occurred on 10/3/2025. LPA was greeted by staff- Carolina La Ra Mendoza and informed her the purpose of visit. Shortly after, at 9:45AM, Beatrice Magdaleno, Early Childhood Administrator (ECA) arrived and met with LPA. LPA took a census of children present. During todays visit, LPA conducted interviews with staff. Based on interviews, LPA was informed by Staff 2- S2 that Staff 1- S1 initially kicked Child 1- C1 on 10/1/2025 and did not mention anything because S2 thought it was an accident. On 10/3/2025, both S2 and Staff 3- S3 witnessed S1 kick C1 on the foot and S2 and S3 both confirmed the incident. After C1 was kicked, S3 moved C1 away from S1 to avoid being kicked again. On 10/6/2025, C1 was sitting next to S1 and S2 witnessed S1 kick C1 twice and S2 informed the ECA about the incident. Staff stated C1 did not cry nor acknowledge being kicked. ECA conducted an investigation dated from 10/6/25 through 10/8/25. The following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the ECA, Beatrice Magdaleno. NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon NAME OF LICENSING PROGRAM ANALYST: Liridon Fici LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2025 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

Type B citation - potential risk if not corrected