LBUSD-TWAIN CHILD DEVELOPMENT CENTER

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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

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

Type B citation - potential risk if not corrected

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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

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) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402. On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground. Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress. Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day. Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision. _____ Continued on page 2 _____ NAME OF LICENSING PROGRAM MANAGER: Warren Birks NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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