PACIFIC PRIMARY

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 November 14, 2025 at approximately 10:25AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, case management visit to the facility in regards to an unusual incident that was self-reported to the department on October 24, 2025. LPA met with Site Supervisor (S1), Natalie Karet, and explained the purpose of the visit. Present during LPA's visit included 19 staff supervising 68 preschool age children. Director (D1), Ilsa Miller, joined the visit by phone. The self-reported incident occurred on October 24, 2025 in the outdoor activity area. A child’s (C1) class was transitioning indoors and a staff member (S2) noticed C1 was not with the group. The classroom has a direct door leading to the outside area and S2 quickly went outside and found C1 cleaning up behind a play structure. Per incident report, teachers always do a visual scan of the area before transitioning but had missed the area C1 was in. C1 was unsupervised for approximately one minute and was not in distress when found. D1 informed C1's authorized representative of incident. D1 and S1 have implemented facility procedures that include a Safety Walkthrough Checklist to ensure staff maintain active supervision throughout the day and a headcount check system amongst staff. The facility also plans to purchase mirrors to prevent blind spots in the outdoor area. Continued on Page Two NAME OF LICENSING PROGRAM MANAGER: Ali Zebila NAME OF LICENSING PROGRAM ANALYST: Nicole Tran LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/14/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2025 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 The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any

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 November 14, 2025 at approximately 10:25AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, case management visit to the facility in regards to an unusual incident that was self-reported to the department on October 24, 2025. LPA met with Site Supervisor (S1), Natalie Karet, and explained the purpose of the visit. Present during LPA's visit included 19 staff supervising 68 preschool age children. Director (D1), Ilsa Miller, joined the visit by phone. The self-reported incident occurred on October 24, 2025 in the outdoor activity area. A child’s (C1) class was transitioning indoors and a staff member (S2) noticed C1 was not with the group. The classroom has a direct door leading to the outside area and S2 quickly went outside and found C1 cleaning up behind a play structure. Per incident report, teachers always do a visual scan of the area before transitioning but had missed the area C1 was in. C1 was unsupervised for approximately one minute and was not in distress when found. D1 informed C1's authorized representative of incident. D1 and S1 have implemented facility procedures that include a Safety Walkthrough Checklist to ensure staff maintain active supervision throughout the day and a headcount check system amongst staff. The facility also plans to purchase mirrors to prevent blind spots in the outdoor area. Continued on Page Two NAME OF LICENSING PROGRAM MANAGER: Ali Zebila NAME OF LICENSING PROGRAM ANALYST: Nicole Tran LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/14/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2025 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 The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any

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 November 14, 2025 at approximately 10:25AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, case management visit to the facility in regards to an unusual incident that was self-reported to the department on October 24, 2025. LPA met with Site Supervisor (S1), Natalie Karet, and explained the purpose of the visit. Present during LPA's visit included 19 staff supervising 68 preschool age children. Director (D1), Ilsa Miller, joined the visit by phone. The self-reported incident occurred on October 24, 2025 in the outdoor activity area. A child’s (C1) class was transitioning indoors and a staff member (S2) noticed C1 was not with the group. The classroom has a direct door leading to the outside area and S2 quickly went outside and found C1 cleaning up behind a play structure. Per incident report, teachers always do a visual scan of the area before transitioning but had missed the area C1 was in. C1 was unsupervised for approximately one minute and was not in distress when found. D1 informed C1's authorized representative of incident. D1 and S1 have implemented facility procedures that include a Safety Walkthrough Checklist to ensure staff maintain active supervision throughout the day and a headcount check system amongst staff. The facility also plans to purchase mirrors to prevent blind spots in the outdoor area. Continued on Page Two NAME OF LICENSING PROGRAM MANAGER: Ali Zebila NAME OF LICENSING PROGRAM ANALYST: Nicole Tran LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/14/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2025 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 The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any

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 November 14, 2025 at approximately 10:25AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, case management visit to the facility in regards to an unusual incident that was self-reported to the department on October 24, 2025. LPA met with Site Supervisor (S1), Natalie Karet, and explained the purpose of the visit. Present during LPA's visit included 19 staff supervising 68 preschool age children. Director (D1), Ilsa Miller, joined the visit by phone. The self-reported incident occurred on October 24, 2025 in the outdoor activity area. A child’s (C1) class was transitioning indoors and a staff member (S2) noticed C1 was not with the group. The classroom has a direct door leading to the outside area and S2 quickly went outside and found C1 cleaning up behind a play structure. Per incident report, teachers always do a visual scan of the area before transitioning but had missed the area C1 was in. C1 was unsupervised for approximately one minute and was not in distress when found. D1 informed C1's authorized representative of incident. D1 and S1 have implemented facility procedures that include a Safety Walkthrough Checklist to ensure staff maintain active supervision throughout the day and a headcount check system amongst staff. The facility also plans to purchase mirrors to prevent blind spots in the outdoor area. Continued on Page Two NAME OF LICENSING PROGRAM MANAGER: Ali Zebila NAME OF LICENSING PROGRAM ANALYST: Nicole Tran LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/14/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2025 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 The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any