NUFFER ELEMENTARY

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25The Licensing Program Analyst (LPA), T. Tran, conducted a site visit to follow up a case management incident occurred on 01/11/22. About 12:15PM, LPA met with Loretta Gallegos, Assistant Director and toured the facility inside and outside. LPA completed child’s review, obtained child's document and personnel report. Staff files located at the main office, LPA will arrange another visit for files review. Children, staff, and other members were interviewed. Based on information gathered through interviews, on 1/11/2022 about 3:30PM C1 was left alone at the enclosed play yard for about 1 to 2 minutes. Per interviewed staff they failed to count the children when transition from outdoor play to the classroom. Within that moment, parent of C1 arrived and staff noticed child was not in the classroom and that same time child saw dad and came out from the Caterpillar from the yard. Child observed to be no harm by this incident. Based on the observation, the facility was double gated and child was still within the premises of the school. Therefore, the facility is being cited for lack of care and supervision. Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Loretta Gallegos. SUPERVISORS NAME: Trevino Cochran LICENSING EVALUATOR NAME: Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022 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: NUFFER ELEMENTARY FACILITY NUMBER: 198013724 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/25/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 06/01/2022 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7Responsible for Providing Care and Supervision. This requirement is not met as evidenced by based on interviews conducted facility failed to provide proper care for a child enrolled. On 1/11/2022 about 3:30PM C1 was left alone at the enclosed play yard for about 1 to 2 minutes which poses a potential health and safety risk to children in care. 1 2 3 4 5 6 7Director agrees to submit a plan of correction by reviewing with center staff the school protocol for counting the children during transitions including care and supervision. Copy of staff attendance and training materials will submit to CCLD by or before 6/1/2022 in order to clear this citation. 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 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:Trevino Cochran LICENSING EVALUATOR NAME:Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25The Licensing Program Analyst (LPA), T. Tran, conducted a site visit to follow up a case management incident occurred on 01/11/22. About 12:15PM, LPA met with Loretta Gallegos, Assistant Director and toured the facility inside and outside. LPA completed child’s review, obtained child's document and personnel report. Staff files located at the main office, LPA will arrange another visit for files review. Children, staff, and other members were interviewed. Based on information gathered through interviews, on 1/11/2022 about 3:30PM C1 was left alone at the enclosed play yard for about 1 to 2 minutes. Per interviewed staff they failed to count the children when transition from outdoor play to the classroom. Within that moment, parent of C1 arrived and staff noticed child was not in the classroom and that same time child saw dad and came out from the Caterpillar from the yard. Child observed to be no harm by this incident. Based on the observation, the facility was double gated and child was still within the premises of the school. Therefore, the facility is being cited for lack of care and supervision. Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Loretta Gallegos. SUPERVISORS NAME: Trevino Cochran LICENSING EVALUATOR NAME: Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022 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: NUFFER ELEMENTARY FACILITY NUMBER: 198013724 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/25/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 06/01/2022 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7Responsible for Providing Care and Supervision. This requirement is not met as evidenced by based on interviews conducted facility failed to provide proper care for a child enrolled. On 1/11/2022 about 3:30PM C1 was left alone at the enclosed play yard for about 1 to 2 minutes which poses a potential health and safety risk to children in care. 1 2 3 4 5 6 7Director agrees to submit a plan of correction by reviewing with center staff the school protocol for counting the children during transitions including care and supervision. Copy of staff attendance and training materials will submit to CCLD by or before 6/1/2022 in order to clear this citation. 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 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:Trevino Cochran LICENSING EVALUATOR NAME:Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022

Type B citation - potential risk if not corrected