GOOD SHEPHERD'S FOLD 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 01/29/2025, Licensing Program Analyst (LPA) Tyra Chavies conducted an unannounced case management- incident visit to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 12/26/2024. Upon arrival, LPA met with Director, Yolanda Mojarro. LPA informed director about the purpose of the visit and toured the facility. LPA observed 18 children being supervised by 3 teachers. Incident Details: 4:15 PM on 12/26/2024, Tiana was sitting in a chair and had a seizure. I called the paramedic and then I called mom. Then the paramedic came at 4:20 pm, then the grandmother came and then mom called back. Once mom got there she left with the paramedics. Mom called and said she had a fever seizure. The child has not returned back to school. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025 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 2 FACILITY NAME: GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER: 197495108 VISIT DATE: 02/07/2025 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 32On 01/03/2025 LPA Chavies observed children in care, conducted interviews with director, C1, C2, C3, C4 and S1 and received personnel documents On 01/09/2025 LPA Chavies conducted interviews with P1 and P4 On 01/10/2025 LPA Chavies conducted interviews with P2 and P3. Based on interviews conducted and review of personnel documentation, when the director seen C1 having a seizure the director called paramedics and assisted child during incident, the director did follow proper procedures.   No deficiencies were cited. Exit interview was conducted and a copy of the report was provided to Director, Yolanda Mojarro. Notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025

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 01/29/2025, Licensing Program Analyst (LPA) Tyra Chavies conducted an unannounced case management- incident visit to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 12/26/2024. Upon arrival, LPA met with Director, Yolanda Mojarro. LPA informed director about the purpose of the visit and toured the facility. LPA observed 18 children being supervised by 3 teachers. Incident Details: 4:15 PM on 12/26/2024, Tiana was sitting in a chair and had a seizure. I called the paramedic and then I called mom. Then the paramedic came at 4:20 pm, then the grandmother came and then mom called back. Once mom got there she left with the paramedics. Mom called and said she had a fever seizure. The child has not returned back to school. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025 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 2 FACILITY NAME: GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER: 197495108 VISIT DATE: 02/07/2025 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 32On 01/03/2025 LPA Chavies observed children in care, conducted interviews with director, C1, C2, C3, C4 and S1 and received personnel documents On 01/09/2025 LPA Chavies conducted interviews with P1 and P4 On 01/10/2025 LPA Chavies conducted interviews with P2 and P3. Based on interviews conducted and review of personnel documentation, when the director seen C1 having a seizure the director called paramedics and assisted child during incident, the director did follow proper procedures.   No deficiencies were cited. Exit interview was conducted and a copy of the report was provided to Director, Yolanda Mojarro. Notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025

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

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 01/29/2025, Licensing Program Analyst (LPA) Tyra Chavies conducted an unannounced case management- incident visit to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 12/26/2024. Upon arrival, LPA met with Director, Yolanda Mojarro. LPA informed director about the purpose of the visit and toured the facility. LPA observed 18 children being supervised by 3 teachers. Incident Details: 4:15 PM on 12/26/2024, Tiana was sitting in a chair and had a seizure. I called the paramedic and then I called mom. Then the paramedic came at 4:20 pm, then the grandmother came and then mom called back. Once mom got there she left with the paramedics. Mom called and said she had a fever seizure. The child has not returned back to school. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025 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 2 FACILITY NAME: GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER: 197495108 VISIT DATE: 02/07/2025 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 32On 01/03/2025 LPA Chavies observed children in care, conducted interviews with director, C1, C2, C3, C4 and S1 and received personnel documents On 01/09/2025 LPA Chavies conducted interviews with P1 and P4 On 01/10/2025 LPA Chavies conducted interviews with P2 and P3. Based on interviews conducted and review of personnel documentation, when the director seen C1 having a seizure the director called paramedics and assisted child during incident, the director did follow proper procedures.   No deficiencies were cited. Exit interview was conducted and a copy of the report was provided to Director, Yolanda Mojarro. Notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025

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 01/29/2025, Licensing Program Analyst (LPA) Tyra Chavies conducted an unannounced case management- incident visit to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 12/26/2024. Upon arrival, LPA met with Director, Yolanda Mojarro. LPA informed director about the purpose of the visit and toured the facility. LPA observed 18 children being supervised by 3 teachers. Incident Details: 4:15 PM on 12/26/2024, Tiana was sitting in a chair and had a seizure. I called the paramedic and then I called mom. Then the paramedic came at 4:20 pm, then the grandmother came and then mom called back. Once mom got there she left with the paramedics. Mom called and said she had a fever seizure. The child has not returned back to school. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025 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 2 FACILITY NAME: GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER: 197495108 VISIT DATE: 02/07/2025 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 32On 01/03/2025 LPA Chavies observed children in care, conducted interviews with director, C1, C2, C3, C4 and S1 and received personnel documents On 01/09/2025 LPA Chavies conducted interviews with P1 and P4 On 01/10/2025 LPA Chavies conducted interviews with P2 and P3. Based on interviews conducted and review of personnel documentation, when the director seen C1 having a seizure the director called paramedics and assisted child during incident, the director did follow proper procedures.   No deficiencies were cited. Exit interview was conducted and a copy of the report was provided to Director, Yolanda Mojarro. Notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Karren Starks LICENSING EVALUATOR NAME: Tyra Chavies LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025

Type B citation from complaint investigation - potential risk if not corrected