ST. JUNIPERO SERRA CATHOLIC 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 25On 1/28/2026 an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Kathy Trinh in response to a self-reported incident dated 1/23/2026. LPA met with Facility Representative Michelle Bentley and was led on a tour. There were 21 napping preschool children and 3 staff present at the time of inspection. Hours of operation are 6:45AM-6:00PM, Monday through Friday. A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The Department received an incident report on 1/23/2026 stating that on 1/23/2026 at 10:00AM, Staff 2 (S2) told Child 1 (C1) to go potty as they were transitioning from the classroom to the playground. S2 then grabbed the emergency backpack and forgot that C1 was still in the restroom. Staff 1 (S1) confirmed with S2 that the children were ready to go outside, and they transitioned to the playground. S1 then realized C1 was left behind and walked back to the classroom during their break. S1 saw C1 in the classroom alone crying in the restroom. Based on the video camera footage reviewed by the Director, C1 was alone in the classroom for a total of four (4) minutes. During the investigation, LPA conducted interviews with two (2) staff members. Both staff interviewed confirmed that C1 was left unattended in the classroom bathroom for a few minutes after the rest of the class had made their way to the playground. The interviewed staff also shared that the staff present during the time of the incident did not count how many children they had as they transitioned from the classroom to the playground. (Continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/28/2026 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2026 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 l

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 1/28/2026 an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Kathy Trinh in response to a self-reported incident dated 1/23/2026. LPA met with Facility Representative Michelle Bentley and was led on a tour. There were 21 napping preschool children and 3 staff present at the time of inspection. Hours of operation are 6:45AM-6:00PM, Monday through Friday. A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The Department received an incident report on 1/23/2026 stating that on 1/23/2026 at 10:00AM, Staff 2 (S2) told Child 1 (C1) to go potty as they were transitioning from the classroom to the playground. S2 then grabbed the emergency backpack and forgot that C1 was still in the restroom. Staff 1 (S1) confirmed with S2 that the children were ready to go outside, and they transitioned to the playground. S1 then realized C1 was left behind and walked back to the classroom during their break. S1 saw C1 in the classroom alone crying in the restroom. Based on the video camera footage reviewed by the Director, C1 was alone in the classroom for a total of four (4) minutes. During the investigation, LPA conducted interviews with two (2) staff members. Both staff interviewed confirmed that C1 was left unattended in the classroom bathroom for a few minutes after the rest of the class had made their way to the playground. The interviewed staff also shared that the staff present during the time of the incident did not count how many children they had as they transitioned from the classroom to the playground. (Continue to page 2) NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/28/2026 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2026 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 l

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