MENDOZA C.D.C., RM. P9

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 This is a Case Management For EHS Rm 10. At 1:00Pm LPA Kamile Martin spoke with teacher 2 in regards to UIR unusual incident report received on 5/22/25. via email. On 5/27/25 LPA KMartin arrived at Mendoza EHS rm 10. To see if child had arrived for the day. A census was conducted and 8 children and two teachers (1 Substitute) are in the classroom. Teacher 2 said children just finished lunch and were a sleeping. Teacher 1 was absent today. She made the report and notified supervisor of the incident. Upon observation Social Worker arrived to the classroom to follow up on the incident of the child as well. Because children were sleeping Social worker provided her information and will return tomorrow morning for further investigation Child is two years old and her home language is Spanish. She does respond in English sometimes. Child woke up from nap at 1:55 and LPA KMartin spoke with child briefly, child was still waking up and not coherent. Teacher 2 notified LPA child may be going home soon. The child;s mother or Aunt picks up the child at 2:00 no later than 2:30. It was disclosed that child has experienced unusual behavior lately. Child has been observed rubbing her chest area through out the day and often soothes her body to sleep by rubbing her chest. It was also observed child's behavior has changed recently she has been observed being mean to friends and hitting peers. Since the child has disclosed information about abuse the father no longer picks the child up from school. Home visits were conducted in March both teachers were present for the visit and both parents were home for the visit as well. NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman NAME OF LICENSING PROGRAM ANALYST: Kamile Martin LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/27/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2025 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 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 to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES

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 25 This is a Case Management For EHS Rm 10. At 1:00Pm LPA Kamile Martin spoke with teacher 2 in regards to UIR unusual incident report received on 5/22/25. via email. On 5/27/25 LPA KMartin arrived at Mendoza EHS rm 10. To see if child had arrived for the day. A census was conducted and 8 children and two teachers (1 Substitute) are in the classroom. Teacher 2 said children just finished lunch and were a sleeping. Teacher 1 was absent today. She made the report and notified supervisor of the incident. Upon observation Social Worker arrived to the classroom to follow up on the incident of the child as well. Because children were sleeping Social worker provided her information and will return tomorrow morning for further investigation Child is two years old and her home language is Spanish. She does respond in English sometimes. Child woke up from nap at 1:55 and LPA KMartin spoke with child briefly, child was still waking up and not coherent. Teacher 2 notified LPA child may be going home soon. The child;s mother or Aunt picks up the child at 2:00 no later than 2:30. It was disclosed that child has experienced unusual behavior lately. Child has been observed rubbing her chest area through out the day and often soothes her body to sleep by rubbing her chest. It was also observed child's behavior has changed recently she has been observed being mean to friends and hitting peers. Since the child has disclosed information about abuse the father no longer picks the child up from school. Home visits were conducted in March both teachers were present for the visit and both parents were home for the visit as well. NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman NAME OF LICENSING PROGRAM ANALYST: Kamile Martin LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/27/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2025 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 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 to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES