RAINBOW RISING - LOMA RIDGE

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Page One Licensing Program Analyst (LPA) Castro conducted a case management inspection to follow up on a self-reported unusual incident that was submitted to CCL Regional Licensing Office on 09/17/2025. It was reported by Courtney Kozloski, Director via phone. According to director, Staff 1 (S1) served Child 1 (C1) animal crackers and string cheese before C1 began exhibiting symptoms of a mild allergic reaction. The animal cracker contained an ingredient that C1 is allergic to. As a precaution, C1's parent/caretaker called 911 so that child C1 to be assessed. During today's inspection a tour of the facility was conducted and census was taken: LPA observed 79 children in the classroom with 8 teaches, including director. During today's inspection, the facility was observed operating within its licensed capacity and within compliance of staff to child ratios. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Three staff were interviewed. LPA was informed that a staff training covering allergies and dietary restrictions will be conducted next week. Staff has already reviewed known allergies/dietary restrictions for children enrolled. According to LPA's observations, interviews and record review, a type A deficiency will be cited during today's vist. Please refer to LIC809D for more details. Page 1 of 2 NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran NAME OF LICENSING PROGRAM ANALYST: Alma Castro LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/24/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2025 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 4 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 the licensing agency, or subject

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Page One Licensing Program Analyst (LPA) Castro conducted a case management inspection to follow up on a self-reported unusual incident that was submitted to CCL Regional Licensing Office on 09/17/2025. It was reported by Courtney Kozloski, Director via phone. According to director, Staff 1 (S1) served Child 1 (C1) animal crackers and string cheese before C1 began exhibiting symptoms of a mild allergic reaction. The animal cracker contained an ingredient that C1 is allergic to. As a precaution, C1's parent/caretaker called 911 so that child C1 to be assessed. During today's inspection a tour of the facility was conducted and census was taken: LPA observed 79 children in the classroom with 8 teaches, including director. During today's inspection, the facility was observed operating within its licensed capacity and within compliance of staff to child ratios. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Three staff were interviewed. LPA was informed that a staff training covering allergies and dietary restrictions will be conducted next week. Staff has already reviewed known allergies/dietary restrictions for children enrolled. According to LPA's observations, interviews and record review, a type A deficiency will be cited during today's vist. Please refer to LIC809D for more details. Page 1 of 2 NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran NAME OF LICENSING PROGRAM ANALYST: Alma Castro LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/24/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2025 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 4 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 the licensing agency, or subject

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