VVUSD MEAD VALLEY ELEMENTARY

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

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) Sumayya Habeebulla arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 05/23/24 from the facility stating an incident that occurred in Room 6. LPA conducted interviews with pertaining parties, and it was found that on Monday, 05/13/24 S1 smashed the toy phones using a hammer in front of the children. During the morning session, as per Staff 1(S1) children were ‘bickering and fighting’ over the shared use of the toy phones. S1 retrieved a hammer from the drawer which is located in the classroom and smashed the toys. Child 1 (C1) shared this incident with their parent who reported it to the school administration. There were 18 students present in Room 6 on the day of the incident and 2 assistants. C1 does not attend the facility anymore due to the incident and the last day of attendance was of 05/13/24. From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101223(a)(3) Personal Rights. See LIC 809D for deficiencies cited. An exit interview was conducted with the Facility Representative Ms. Andrea Rodich-Vitek, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time. SUPERVISORS NAME: Carlos Martinez LICENSING EVALUATOR NAME: Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024 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: VVUSD MEAD VALLEY ELEMENTARY FACILITY NUMBER: 334842375 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/29/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/03/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223(a)(3) Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, … humiliation, intimidation… threat, or other actions of a punitive nature… to physical functioning. 1 2 3 4 5 6 7The Facility Director agrees to review Title 22 section Personal Rights with Staff 1. The Facility Director will provide a copy of the written plan for staff 1 to the Department by the due date. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on interviews S1 smashed the toy phones in front of the childcare children to stop their fighting over the shared toy phones using a real hammer.8 9 10 11 12 13 14 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:Carlos Martinez LICENSING EVALUATOR NAME:Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024

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) Sumayya Habeebulla arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 05/23/24 from the facility stating an incident that occurred in Room 6. LPA conducted interviews with pertaining parties, and it was found that on Monday, 05/13/24 S1 smashed the toy phones using a hammer in front of the children. During the morning session, as per Staff 1(S1) children were ‘bickering and fighting’ over the shared use of the toy phones. S1 retrieved a hammer from the drawer which is located in the classroom and smashed the toys. Child 1 (C1) shared this incident with their parent who reported it to the school administration. There were 18 students present in Room 6 on the day of the incident and 2 assistants. C1 does not attend the facility anymore due to the incident and the last day of attendance was of 05/13/24. From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101223(a)(3) Personal Rights. See LIC 809D for deficiencies cited. An exit interview was conducted with the Facility Representative Ms. Andrea Rodich-Vitek, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time. SUPERVISORS NAME: Carlos Martinez LICENSING EVALUATOR NAME: Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024 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: VVUSD MEAD VALLEY ELEMENTARY FACILITY NUMBER: 334842375 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/29/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/03/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223(a)(3) Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, … humiliation, intimidation… threat, or other actions of a punitive nature… to physical functioning. 1 2 3 4 5 6 7The Facility Director agrees to review Title 22 section Personal Rights with Staff 1. The Facility Director will provide a copy of the written plan for staff 1 to the Department by the due date. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on interviews S1 smashed the toy phones in front of the childcare children to stop their fighting over the shared toy phones using a real hammer.8 9 10 11 12 13 14 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:Carlos Martinez LICENSING EVALUATOR NAME:Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024

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) Sumayya Habeebulla arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 05/23/24 from the facility stating an incident that occurred in Room 6. LPA conducted interviews with pertaining parties, and it was found that on Monday, 05/13/24 S1 smashed the toy phones using a hammer in front of the children. During the morning session, as per Staff 1(S1) children were ‘bickering and fighting’ over the shared use of the toy phones. S1 retrieved a hammer from the drawer which is located in the classroom and smashed the toys. Child 1 (C1) shared this incident with their parent who reported it to the school administration. There were 18 students present in Room 6 on the day of the incident and 2 assistants. C1 does not attend the facility anymore due to the incident and the last day of attendance was of 05/13/24. From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101223(a)(3) Personal Rights. See LIC 809D for deficiencies cited. An exit interview was conducted with the Facility Representative Ms. Andrea Rodich-Vitek, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time. SUPERVISORS NAME: Carlos Martinez LICENSING EVALUATOR NAME: Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024 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: VVUSD MEAD VALLEY ELEMENTARY FACILITY NUMBER: 334842375 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/29/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/03/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223(a)(3) Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, … humiliation, intimidation… threat, or other actions of a punitive nature… to physical functioning. 1 2 3 4 5 6 7The Facility Director agrees to review Title 22 section Personal Rights with Staff 1. The Facility Director will provide a copy of the written plan for staff 1 to the Department by the due date. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on interviews S1 smashed the toy phones in front of the childcare children to stop their fighting over the shared toy phones using a real hammer.8 9 10 11 12 13 14 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:Carlos Martinez LICENSING EVALUATOR NAME:Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024

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) Sumayya Habeebulla arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 05/23/24 from the facility stating an incident that occurred in Room 6. LPA conducted interviews with pertaining parties, and it was found that on Monday, 05/13/24 S1 smashed the toy phones using a hammer in front of the children. During the morning session, as per Staff 1(S1) children were ‘bickering and fighting’ over the shared use of the toy phones. S1 retrieved a hammer from the drawer which is located in the classroom and smashed the toys. Child 1 (C1) shared this incident with their parent who reported it to the school administration. There were 18 students present in Room 6 on the day of the incident and 2 assistants. C1 does not attend the facility anymore due to the incident and the last day of attendance was of 05/13/24. From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101223(a)(3) Personal Rights. See LIC 809D for deficiencies cited. An exit interview was conducted with the Facility Representative Ms. Andrea Rodich-Vitek, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time. SUPERVISORS NAME: Carlos Martinez LICENSING EVALUATOR NAME: Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024 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: VVUSD MEAD VALLEY ELEMENTARY FACILITY NUMBER: 334842375 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/29/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/03/2024 Section Cited CCR 101223(a)(3) 1 2 3 4 5 6 7101223(a)(3) Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, … humiliation, intimidation… threat, or other actions of a punitive nature… to physical functioning. 1 2 3 4 5 6 7The Facility Director agrees to review Title 22 section Personal Rights with Staff 1. The Facility Director will provide a copy of the written plan for staff 1 to the Department by the due date. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on interviews S1 smashed the toy phones in front of the childcare children to stop their fighting over the shared toy phones using a real hammer.8 9 10 11 12 13 14 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:Carlos Martinez LICENSING EVALUATOR NAME:Sumayya Habeebulla LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024