SBCSS LEVI DICKEY STATE PRESCHOOL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25LPA Lama arrived at the facility to follow up on a self-reported incident that occurred at the facility on March 7, 2025. LPA was met with site director, Maria Galindo. LPA stated the purpose of the visit, took census and toured the classroom. LPA also conducted interviews with pertinent parties, and reviewed documentation. The self-reported incident involved a child who was running towards the exit door during dismissal. During this time, a staff attempted to stop the child by reaching their hand out to grab them by the back of their shirt near their lower back, but ended up scratching the child's neck in the process. Although staff reported that the mother was standing at the door and witnessed the entire incident, as well as "no visible marks on neck reported by" subject child's mother, there was a violation of children's personal rights. LPA Aman Lama informed the site director, Maria Galindo to provide a copy of this licensing report dated April 7, 2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled, or newly enrolled by the next business day or the next day the child(ren) is(are) in care. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification and kept on file for 12 months from the date of this report. A citation is being issued for Personal Rights- See LIC809-D for cited deficiencies. LPA Aman Lama informed site director, Maria Galindo that this report dated April 7, 2025 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is(are) immediate risk(s) to the health, safety, or personal rights of children in care. An exit interview was conducted and report was reviewed with site director, Maria Galindo. NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena NAME OF LICENSING PROGRAM ANALYST: Aman Lama LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2025 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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25LPA Lama arrived at the facility to follow up on a self-reported incident that occurred at the facility on March 7, 2025. LPA was met with site director, Maria Galindo. LPA stated the purpose of the visit, took census and toured the classroom. LPA also conducted interviews with pertinent parties, and reviewed documentation. The self-reported incident involved a child who was running towards the exit door during dismissal. During this time, a staff attempted to stop the child by reaching their hand out to grab them by the back of their shirt near their lower back, but ended up scratching the child's neck in the process. Although staff reported that the mother was standing at the door and witnessed the entire incident, as well as "no visible marks on neck reported by" subject child's mother, there was a violation of children's personal rights. LPA Aman Lama informed the site director, Maria Galindo to provide a copy of this licensing report dated April 7, 2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled, or newly enrolled by the next business day or the next day the child(ren) is(are) in care. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification and kept on file for 12 months from the date of this report. A citation is being issued for Personal Rights- See LIC809-D for cited deficiencies. LPA Aman Lama informed site director, Maria Galindo that this report dated April 7, 2025 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is(are) immediate risk(s) to the health, safety, or personal rights of children in care. An exit interview was conducted and report was reviewed with site director, Maria Galindo. NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena NAME OF LICENSING PROGRAM ANALYST: Aman Lama LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2025 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

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