KCE CHAMPIONS @ BELLA VISTA ELEMENTARY

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

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 10/29/2025 at 2:13pm Licensing Program Analyst (LPA) Morgan Pringle met with Director Samina Unni for an Unannounced Annual/Random Inspection. There were thirty-seven (37) school age children, and eight (8) additional staff present during the inspection. The facility operates on the far-left side of the Bella Vista Elementary School campus in building DC100. The facility operates in rooms D101, D102, C100 (Library) and M104 (Multipurpose Room). Only rooms D101 and D102 are currently being used. Both classrooms were toured for a health and safety inspection. The facility operates from 6:30am – 6:30pm Monday – Friday. The facility has ample age-appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The two (2) children’s bathrooms were observed to be clean and in good condition. There is a separate staff bathroom on site as well. There are multiple fully charged fire extinguishers, carbon monoxide detectors, and smoke detectors on site. Facility does not transport children. All Transitional Kindergarten (TK) and Kindergartners are brought to the facility by their teachers. All other children walk to the facility on their own. All hazards in the kitchen have been made inaccessible to the children in care. All food on site is properly labeled and stored. Facility only provides snacks for the children. When children are present all day the children are required to bring their own lunch. All food that will be brought from the children’s home will be properly labeled and stored. All children bring their own water bottles and have access to clean drinking water. Page 1 of 3 NAME OF LICENSING PROGRAM MANAGER: Jason Jang NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025 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 5 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 s

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 10/29/2025 at 2:13pm Licensing Program Analyst (LPA) Morgan Pringle met with Director Samina Unni for an Unannounced Annual/Random Inspection. There were thirty-seven (37) school age children, and eight (8) additional staff present during the inspection. The facility operates on the far-left side of the Bella Vista Elementary School campus in building DC100. The facility operates in rooms D101, D102, C100 (Library) and M104 (Multipurpose Room). Only rooms D101 and D102 are currently being used. Both classrooms were toured for a health and safety inspection. The facility operates from 6:30am – 6:30pm Monday – Friday. The facility has ample age-appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The two (2) children’s bathrooms were observed to be clean and in good condition. There is a separate staff bathroom on site as well. There are multiple fully charged fire extinguishers, carbon monoxide detectors, and smoke detectors on site. Facility does not transport children. All Transitional Kindergarten (TK) and Kindergartners are brought to the facility by their teachers. All other children walk to the facility on their own. All hazards in the kitchen have been made inaccessible to the children in care. All food on site is properly labeled and stored. Facility only provides snacks for the children. When children are present all day the children are required to bring their own lunch. All food that will be brought from the children’s home will be properly labeled and stored. All children bring their own water bottles and have access to clean drinking water. Page 1 of 3 NAME OF LICENSING PROGRAM MANAGER: Jason Jang NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025 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 5 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 s

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 10/29/2025 at 2:13pm Licensing Program Analyst (LPA) Morgan Pringle met with Director Samina Unni for an Unannounced Annual/Random Inspection. There were thirty-seven (37) school age children, and eight (8) additional staff present during the inspection. The facility operates on the far-left side of the Bella Vista Elementary School campus in building DC100. The facility operates in rooms D101, D102, C100 (Library) and M104 (Multipurpose Room). Only rooms D101 and D102 are currently being used. Both classrooms were toured for a health and safety inspection. The facility operates from 6:30am – 6:30pm Monday – Friday. The facility has ample age-appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The two (2) children’s bathrooms were observed to be clean and in good condition. There is a separate staff bathroom on site as well. There are multiple fully charged fire extinguishers, carbon monoxide detectors, and smoke detectors on site. Facility does not transport children. All Transitional Kindergarten (TK) and Kindergartners are brought to the facility by their teachers. All other children walk to the facility on their own. All hazards in the kitchen have been made inaccessible to the children in care. All food on site is properly labeled and stored. Facility only provides snacks for the children. When children are present all day the children are required to bring their own lunch. All food that will be brought from the children’s home will be properly labeled and stored. All children bring their own water bottles and have access to clean drinking water. Page 1 of 3 NAME OF LICENSING PROGRAM MANAGER: Jason Jang NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025 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 5 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 s

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 10/29/2025 at 2:13pm Licensing Program Analyst (LPA) Morgan Pringle met with Director Samina Unni for an Unannounced Annual/Random Inspection. There were thirty-seven (37) school age children, and eight (8) additional staff present during the inspection. The facility operates on the far-left side of the Bella Vista Elementary School campus in building DC100. The facility operates in rooms D101, D102, C100 (Library) and M104 (Multipurpose Room). Only rooms D101 and D102 are currently being used. Both classrooms were toured for a health and safety inspection. The facility operates from 6:30am – 6:30pm Monday – Friday. The facility has ample age-appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The two (2) children’s bathrooms were observed to be clean and in good condition. There is a separate staff bathroom on site as well. There are multiple fully charged fire extinguishers, carbon monoxide detectors, and smoke detectors on site. Facility does not transport children. All Transitional Kindergarten (TK) and Kindergartners are brought to the facility by their teachers. All other children walk to the facility on their own. All hazards in the kitchen have been made inaccessible to the children in care. All food on site is properly labeled and stored. Facility only provides snacks for the children. When children are present all day the children are required to bring their own lunch. All food that will be brought from the children’s home will be properly labeled and stored. All children bring their own water bottles and have access to clean drinking water. Page 1 of 3 NAME OF LICENSING PROGRAM MANAGER: Jason Jang NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025 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 5 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 s

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 10/29/2025 at 2:13pm Licensing Program Analyst (LPA) Morgan Pringle met with Director Samina Unni for an Unannounced Annual/Random Inspection. There were thirty-seven (37) school age children, and eight (8) additional staff present during the inspection. The facility operates on the far-left side of the Bella Vista Elementary School campus in building DC100. The facility operates in rooms D101, D102, C100 (Library) and M104 (Multipurpose Room). Only rooms D101 and D102 are currently being used. Both classrooms were toured for a health and safety inspection. The facility operates from 6:30am – 6:30pm Monday – Friday. The facility has ample age-appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The two (2) children’s bathrooms were observed to be clean and in good condition. There is a separate staff bathroom on site as well. There are multiple fully charged fire extinguishers, carbon monoxide detectors, and smoke detectors on site. Facility does not transport children. All Transitional Kindergarten (TK) and Kindergartners are brought to the facility by their teachers. All other children walk to the facility on their own. All hazards in the kitchen have been made inaccessible to the children in care. All food on site is properly labeled and stored. Facility only provides snacks for the children. When children are present all day the children are required to bring their own lunch. All food that will be brought from the children’s home will be properly labeled and stored. All children bring their own water bottles and have access to clean drinking water. Page 1 of 3 NAME OF LICENSING PROGRAM MANAGER: Jason Jang NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025 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 5 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 s

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 10/29/2025 at 2:13pm Licensing Program Analyst (LPA) Morgan Pringle met with Director Samina Unni for an Unannounced Annual/Random Inspection. There were thirty-seven (37) school age children, and eight (8) additional staff present during the inspection. The facility operates on the far-left side of the Bella Vista Elementary School campus in building DC100. The facility operates in rooms D101, D102, C100 (Library) and M104 (Multipurpose Room). Only rooms D101 and D102 are currently being used. Both classrooms were toured for a health and safety inspection. The facility operates from 6:30am – 6:30pm Monday – Friday. The facility has ample age-appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The two (2) children’s bathrooms were observed to be clean and in good condition. There is a separate staff bathroom on site as well. There are multiple fully charged fire extinguishers, carbon monoxide detectors, and smoke detectors on site. Facility does not transport children. All Transitional Kindergarten (TK) and Kindergartners are brought to the facility by their teachers. All other children walk to the facility on their own. All hazards in the kitchen have been made inaccessible to the children in care. All food on site is properly labeled and stored. Facility only provides snacks for the children. When children are present all day the children are required to bring their own lunch. All food that will be brought from the children’s home will be properly labeled and stored. All children bring their own water bottles and have access to clean drinking water. Page 1 of 3 NAME OF LICENSING PROGRAM MANAGER: Jason Jang NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025 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 5 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 s