BETHANY LUTHERAN CHURCH PRESCHOOL

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 25Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 09/17/25 at 9:15AM. LPA was met by Director Tamara Simpson who guided analyst on a tour of the facility. LPA observed 73 children in care and 12 adults caring for the children. The center was observed to be within teacher to child ratio at time of inspection. The center was observed to be clean and free of any defects The purpose of this visit is to follow up on an Unusual Incident that was reported to the Department on 08/26/25. During the inspection, LPA made observations and conducted interviews. Individuals interviewed state that S4 was attempting to enter a toy truck in the play yard by putting their weight on the door entering feet first. Individuals interviewed state that entering the toy truck that way caused the the truck to tip over and fall on top of S4. Individuals interviewed state that S2 and S3 were less than 10 feet from where the incident occurred and reacted almost instantly. Individuals stated that S2 brought the child into main office to the Director and an assistant who provided First Aide. Per Director, authorized representatives were called to be informed of the incident and for S4 to be picked up. During record review, LPA observed that all adults in charge of classrooms are qualified teachers. Director states there were 32 children at play when the incident occurred, and 4 qualified adults supervising the children. Individuals interviewed state that S3 has spoken to S4 on how to properly use the playground equipment on the previous day. LPA observed that the toy truck is no longer available for children to play with. Individuals interviewed state that there is always a floater along with the classroom's assigned teacher/s supervising children during outdoor play time. The fact that the incident took place in front of S2 and S3, their immediate reaction to the incident, S3's instruction to S4 on how to properly use outdoor play equipment, and that the center was within teacher to child ratio requirement (1 qualified teacher for every 12 children) indicates the incident did not occur because there was a lack of supervision and/or the center was operating outside of the teacher to child ratio. The center was NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs NAME OF LICENSING PROGRAM ANALYST: Randy Derraco LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025 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 r

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 09/17/25 at 9:15AM. LPA was met by Director Tamara Simpson who guided analyst on a tour of the facility. LPA observed 73 children in care and 12 adults caring for the children. The center was observed to be within teacher to child ratio at time of inspection. The center was observed to be clean and free of any defects The purpose of this visit is to follow up on an Unusual Incident that was reported to the Department on 08/26/25. During the inspection, LPA made observations and conducted interviews. Individuals interviewed state that S4 was attempting to enter a toy truck in the play yard by putting their weight on the door entering feet first. Individuals interviewed state that entering the toy truck that way caused the the truck to tip over and fall on top of S4. Individuals interviewed state that S2 and S3 were less than 10 feet from where the incident occurred and reacted almost instantly. Individuals stated that S2 brought the child into main office to the Director and an assistant who provided First Aide. Per Director, authorized representatives were called to be informed of the incident and for S4 to be picked up. During record review, LPA observed that all adults in charge of classrooms are qualified teachers. Director states there were 32 children at play when the incident occurred, and 4 qualified adults supervising the children. Individuals interviewed state that S3 has spoken to S4 on how to properly use the playground equipment on the previous day. LPA observed that the toy truck is no longer available for children to play with. Individuals interviewed state that there is always a floater along with the classroom's assigned teacher/s supervising children during outdoor play time. The fact that the incident took place in front of S2 and S3, their immediate reaction to the incident, S3's instruction to S4 on how to properly use outdoor play equipment, and that the center was within teacher to child ratio requirement (1 qualified teacher for every 12 children) indicates the incident did not occur because there was a lack of supervision and/or the center was operating outside of the teacher to child ratio. The center was NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs NAME OF LICENSING PROGRAM ANALYST: Randy Derraco LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025 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 r