MISSION NAZARENE PRESCHOOL - INFANT

Type B citation - potential risk if not corrected

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 25On 10/19/23 at 9:15am, Licensing Program Analysts (LPA) Patrick Ma and Martha Avila, visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/2/23. Upon arrival, LPA met with Director, Evelyn Kensel. Present at the facility were 25 day care infants and 9 staff in 3 rooms. Facility was in ratio. During the visit, LPA’s toured the infant care rooms, reviewed the food and bottle storage and labeling, reviewed Needs and Services plans, and conducted interviews with staff. Based on the information gathered, staff S1 incorrectly provided child C1 with a bottle not labeled for them. It was found that the bottles were correctly labeled at the time and that staff member S1 provided the bottle in error. Exit interview conducted and report was reviewed with the facility representative Evelyn Kensel. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023 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: MISSION NAZARENE PRESCHOOL - INFANT FACILITY NUMBER: 376600164 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/19/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/19/2023 Section Cited CCR 101223(a)(2) 1 2 3 4 5 6 7Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations… This requirement was not met as evidenced by: 1 2 3 4 5 6 7Director stated, after the incident they implemented a new proceedural step where staff must verify with a 2nd staff they are porividing the correct bottle to the child before feeding and both the bottle and top of bottle cap is labled with name and date. Deficieny corrected. 8 9 10 11 12 13 14Based on information gather, child C1 was given a bottle to drink that belonged to child C2. Providing a child with a bottle that belongs to another child is a potential risk to their health and safety and/or personal rights. 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:Renesha Askew LICENSING EVALUATOR NAME:Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023

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 10/19/23 at 9:15am, Licensing Program Analysts (LPA) Patrick Ma and Martha Avila, visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/2/23. Upon arrival, LPA met with Director, Evelyn Kensel. Present at the facility were 25 day care infants and 9 staff in 3 rooms. Facility was in ratio. During the visit, LPA’s toured the infant care rooms, reviewed the food and bottle storage and labeling, reviewed Needs and Services plans, and conducted interviews with staff. Based on the information gathered, staff S1 incorrectly provided child C1 with a bottle not labeled for them. It was found that the bottles were correctly labeled at the time and that staff member S1 provided the bottle in error. Exit interview conducted and report was reviewed with the facility representative Evelyn Kensel. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023 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: MISSION NAZARENE PRESCHOOL - INFANT FACILITY NUMBER: 376600164 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/19/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/19/2023 Section Cited CCR 101223(a)(2) 1 2 3 4 5 6 7Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations… This requirement was not met as evidenced by: 1 2 3 4 5 6 7Director stated, after the incident they implemented a new proceedural step where staff must verify with a 2nd staff they are porividing the correct bottle to the child before feeding and both the bottle and top of bottle cap is labled with name and date. Deficieny corrected. 8 9 10 11 12 13 14Based on information gather, child C1 was given a bottle to drink that belonged to child C2. Providing a child with a bottle that belongs to another child is a potential risk to their health and safety and/or personal rights. 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:Renesha Askew LICENSING EVALUATOR NAME:Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023

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 10/19/23 at 9:15am, Licensing Program Analysts (LPA) Patrick Ma and Martha Avila, visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/2/23. Upon arrival, LPA met with Director, Evelyn Kensel. Present at the facility were 25 day care infants and 9 staff in 3 rooms. Facility was in ratio. During the visit, LPA’s toured the infant care rooms, reviewed the food and bottle storage and labeling, reviewed Needs and Services plans, and conducted interviews with staff. Based on the information gathered, staff S1 incorrectly provided child C1 with a bottle not labeled for them. It was found that the bottles were correctly labeled at the time and that staff member S1 provided the bottle in error. Exit interview conducted and report was reviewed with the facility representative Evelyn Kensel. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023 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: MISSION NAZARENE PRESCHOOL - INFANT FACILITY NUMBER: 376600164 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/19/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/19/2023 Section Cited CCR 101223(a)(2) 1 2 3 4 5 6 7Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations… This requirement was not met as evidenced by: 1 2 3 4 5 6 7Director stated, after the incident they implemented a new proceedural step where staff must verify with a 2nd staff they are porividing the correct bottle to the child before feeding and both the bottle and top of bottle cap is labled with name and date. Deficieny corrected. 8 9 10 11 12 13 14Based on information gather, child C1 was given a bottle to drink that belonged to child C2. Providing a child with a bottle that belongs to another child is a potential risk to their health and safety and/or personal rights. 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:Renesha Askew LICENSING EVALUATOR NAME:Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023

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 10/19/23 at 9:15am, Licensing Program Analysts (LPA) Patrick Ma and Martha Avila, visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/2/23. Upon arrival, LPA met with Director, Evelyn Kensel. Present at the facility were 25 day care infants and 9 staff in 3 rooms. Facility was in ratio. During the visit, LPA’s toured the infant care rooms, reviewed the food and bottle storage and labeling, reviewed Needs and Services plans, and conducted interviews with staff. Based on the information gathered, staff S1 incorrectly provided child C1 with a bottle not labeled for them. It was found that the bottles were correctly labeled at the time and that staff member S1 provided the bottle in error. Exit interview conducted and report was reviewed with the facility representative Evelyn Kensel. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023 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: MISSION NAZARENE PRESCHOOL - INFANT FACILITY NUMBER: 376600164 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/19/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/19/2023 Section Cited CCR 101223(a)(2) 1 2 3 4 5 6 7Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations… This requirement was not met as evidenced by: 1 2 3 4 5 6 7Director stated, after the incident they implemented a new proceedural step where staff must verify with a 2nd staff they are porividing the correct bottle to the child before feeding and both the bottle and top of bottle cap is labled with name and date. Deficieny corrected. 8 9 10 11 12 13 14Based on information gather, child C1 was given a bottle to drink that belonged to child C2. Providing a child with a bottle that belongs to another child is a potential risk to their health and safety and/or personal rights. 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:Renesha Askew LICENSING EVALUATOR NAME:Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023