SAN CARLOS UNITED METHODIST WEEKDAY 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 7/24/24 at 8:30 AM, Licensing Program Analyst (LPA) Keturah Lane conducted a case management visit to follow up on an unusual incident that happened at the facility on 4/9/24. Child (C1) may have been injured on the playground and LPA went to the facility to follow up regarding the incident. Upon arrival, LPA met with Director Wendy Koza and toured the facility. LPA observed a total of 68 children in the following classrooms: Classroom #1 had 6 children with staff members Rebecca Lekaunas and Clara Murray Classroom #2 had 9 children with staff members Olivia Zito and Annalisa Sands Classroom #3 had 5 children with staff members Valerie Zito and Maria Anaya Classroom #5 had 11 children with staff members Erica Smithey-Wedel and Lisbeth Uriasvidano Classroom #6 had 3 children with Jessica Blackston and Christina Quick Classroom #7 had 8 children with staff members Emily Vazquez and Celene Gutierrez Classroom #9 had 10 children with staff members Teresa Nguyen and Brianna Disabantonio Classroom #10 had 9 children with staff members Chantilee Mendenhall and Avamarr Morrow Classroom #11 had 7 children with staff members Breanna Cormier and Jenica Hendricks (continued on LIC809-C....) SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024 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: SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOLFACILITY NUMBER: 372000501 VISIT DATE: 07/24/2024 NARRATIVE 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 26 27 28 29 30 31 32During this visit, LPA spoke with two staff that were present during the incident on 4/9/24. C1 was absent today and not available for LPA to interview. LPA spoke with C1's father on the phone regarding the incident. LPA also observed video of C1 leaving the facility and possibly limping. It could not be determined when the child may have been injured or if it occurred while jumping off the 3 feet high blocks that can be moved around the playground. LPA provided technical assistance and advised that staff to redirect the children to another activity when they are jumping off the blocks for safety reasons. No deficiencies were cited during this inspection. Exit interview and report was reviewed with Director Wendy Koza. Notice of site visit was provided and must be posted for 30 days. SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 7/24/24 at 8:30 AM, Licensing Program Analyst (LPA) Keturah Lane conducted a case management visit to follow up on an unusual incident that happened at the facility on 4/9/24. Child (C1) may have been injured on the playground and LPA went to the facility to follow up regarding the incident. Upon arrival, LPA met with Director Wendy Koza and toured the facility. LPA observed a total of 68 children in the following classrooms: Classroom #1 had 6 children with staff members Rebecca Lekaunas and Clara Murray Classroom #2 had 9 children with staff members Olivia Zito and Annalisa Sands Classroom #3 had 5 children with staff members Valerie Zito and Maria Anaya Classroom #5 had 11 children with staff members Erica Smithey-Wedel and Lisbeth Uriasvidano Classroom #6 had 3 children with Jessica Blackston and Christina Quick Classroom #7 had 8 children with staff members Emily Vazquez and Celene Gutierrez Classroom #9 had 10 children with staff members Teresa Nguyen and Brianna Disabantonio Classroom #10 had 9 children with staff members Chantilee Mendenhall and Avamarr Morrow Classroom #11 had 7 children with staff members Breanna Cormier and Jenica Hendricks (continued on LIC809-C....) SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024 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: SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOLFACILITY NUMBER: 372000501 VISIT DATE: 07/24/2024 NARRATIVE 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 26 27 28 29 30 31 32During this visit, LPA spoke with two staff that were present during the incident on 4/9/24. C1 was absent today and not available for LPA to interview. LPA spoke with C1's father on the phone regarding the incident. LPA also observed video of C1 leaving the facility and possibly limping. It could not be determined when the child may have been injured or if it occurred while jumping off the 3 feet high blocks that can be moved around the playground. LPA provided technical assistance and advised that staff to redirect the children to another activity when they are jumping off the blocks for safety reasons. No deficiencies were cited during this inspection. Exit interview and report was reviewed with Director Wendy Koza. Notice of site visit was provided and must be posted for 30 days. SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 7/24/24 at 8:30 AM, Licensing Program Analyst (LPA) Keturah Lane conducted a case management visit to follow up on an unusual incident that happened at the facility on 4/9/24. Child (C1) may have been injured on the playground and LPA went to the facility to follow up regarding the incident. Upon arrival, LPA met with Director Wendy Koza and toured the facility. LPA observed a total of 68 children in the following classrooms: Classroom #1 had 6 children with staff members Rebecca Lekaunas and Clara Murray Classroom #2 had 9 children with staff members Olivia Zito and Annalisa Sands Classroom #3 had 5 children with staff members Valerie Zito and Maria Anaya Classroom #5 had 11 children with staff members Erica Smithey-Wedel and Lisbeth Uriasvidano Classroom #6 had 3 children with Jessica Blackston and Christina Quick Classroom #7 had 8 children with staff members Emily Vazquez and Celene Gutierrez Classroom #9 had 10 children with staff members Teresa Nguyen and Brianna Disabantonio Classroom #10 had 9 children with staff members Chantilee Mendenhall and Avamarr Morrow Classroom #11 had 7 children with staff members Breanna Cormier and Jenica Hendricks (continued on LIC809-C....) SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024 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: SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOLFACILITY NUMBER: 372000501 VISIT DATE: 07/24/2024 NARRATIVE 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 26 27 28 29 30 31 32During this visit, LPA spoke with two staff that were present during the incident on 4/9/24. C1 was absent today and not available for LPA to interview. LPA spoke with C1's father on the phone regarding the incident. LPA also observed video of C1 leaving the facility and possibly limping. It could not be determined when the child may have been injured or if it occurred while jumping off the 3 feet high blocks that can be moved around the playground. LPA provided technical assistance and advised that staff to redirect the children to another activity when they are jumping off the blocks for safety reasons. No deficiencies were cited during this inspection. Exit interview and report was reviewed with Director Wendy Koza. Notice of site visit was provided and must be posted for 30 days. SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 7/24/24 at 8:30 AM, Licensing Program Analyst (LPA) Keturah Lane conducted a case management visit to follow up on an unusual incident that happened at the facility on 4/9/24. Child (C1) may have been injured on the playground and LPA went to the facility to follow up regarding the incident. Upon arrival, LPA met with Director Wendy Koza and toured the facility. LPA observed a total of 68 children in the following classrooms: Classroom #1 had 6 children with staff members Rebecca Lekaunas and Clara Murray Classroom #2 had 9 children with staff members Olivia Zito and Annalisa Sands Classroom #3 had 5 children with staff members Valerie Zito and Maria Anaya Classroom #5 had 11 children with staff members Erica Smithey-Wedel and Lisbeth Uriasvidano Classroom #6 had 3 children with Jessica Blackston and Christina Quick Classroom #7 had 8 children with staff members Emily Vazquez and Celene Gutierrez Classroom #9 had 10 children with staff members Teresa Nguyen and Brianna Disabantonio Classroom #10 had 9 children with staff members Chantilee Mendenhall and Avamarr Morrow Classroom #11 had 7 children with staff members Breanna Cormier and Jenica Hendricks (continued on LIC809-C....) SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024 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: SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOLFACILITY NUMBER: 372000501 VISIT DATE: 07/24/2024 NARRATIVE 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 26 27 28 29 30 31 32During this visit, LPA spoke with two staff that were present during the incident on 4/9/24. C1 was absent today and not available for LPA to interview. LPA spoke with C1's father on the phone regarding the incident. LPA also observed video of C1 leaving the facility and possibly limping. It could not be determined when the child may have been injured or if it occurred while jumping off the 3 feet high blocks that can be moved around the playground. LPA provided technical assistance and advised that staff to redirect the children to another activity when they are jumping off the blocks for safety reasons. No deficiencies were cited during this inspection. Exit interview and report was reviewed with Director Wendy Koza. Notice of site visit was provided and must be posted for 30 days. SUPERVISORS NAME: Tashima Daniel LICENSING EVALUATOR NAME: Keturah Lane LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected