PROVIDENCE 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 April 8, 2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management Incident Inspection at the abovementioned facility. LPA met with Desiree Feller, director, and informed them the purpose of the inspection was to follow up on an incident self reported to the Department on April 3, 2025 as required. LPA was escorted throughout the facility and toured the inside and outside. During the inspection, LPA observed 14 staff and 61 children in care. On April 2, 2025, at approximately 9:00 AM, child 1 was using the restroom located in one of four preschool classrooms and was left unsupervised for approximately 10 minutes during chapel - a group activity with the children and teachers. Staff heard the child and observed that the child was alone in the classroom's restroom. LPA interviewed Director regarding the incident and observed the areas were the incident occurred. LPA interviewed 2 teachers involved in the incident. Based on the information gathered during the inspection, LPA determined that staff took appropriate action in self-reporting the incident. The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind in the restroom. Director states the facility has a plan of action to prevent similar incidences from occurring in the future. During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Notice of site visit was provided, appeal rights were given, and report was reviewed with Director, Desiree Feller. NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025 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: PROVIDENCE PRESCHOOL FACILITY NUMBER: 426215638 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/08/2025 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/22/2025 Section Cited CCR 101229 1 2 3 4 5 6 7(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Facility staff left child unattended and unsupervised in the classroom restroom for approximately 10 minutes.1 2 3 4 5 6 7Director states facility will be taking the following steps: (1) Teachers will conduct a head count of children during group activities and/or moving throughout the facility to and from classrooms. (2) Teachers will document the head count and keep a log and submit proof via emai to Licensing Program Analyst Bill Billones at bill.billones@dss.ca.gov 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 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. Ana Tolentino NAME OF LICENSING PROGRAM MANAGER: Bill-Brian Billones NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025

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 April 8, 2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management Incident Inspection at the abovementioned facility. LPA met with Desiree Feller, director, and informed them the purpose of the inspection was to follow up on an incident self reported to the Department on April 3, 2025 as required. LPA was escorted throughout the facility and toured the inside and outside. During the inspection, LPA observed 14 staff and 61 children in care. On April 2, 2025, at approximately 9:00 AM, child 1 was using the restroom located in one of four preschool classrooms and was left unsupervised for approximately 10 minutes during chapel - a group activity with the children and teachers. Staff heard the child and observed that the child was alone in the classroom's restroom. LPA interviewed Director regarding the incident and observed the areas were the incident occurred. LPA interviewed 2 teachers involved in the incident. Based on the information gathered during the inspection, LPA determined that staff took appropriate action in self-reporting the incident. The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind in the restroom. Director states the facility has a plan of action to prevent similar incidences from occurring in the future. During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Notice of site visit was provided, appeal rights were given, and report was reviewed with Director, Desiree Feller. NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025 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: PROVIDENCE PRESCHOOL FACILITY NUMBER: 426215638 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/08/2025 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/22/2025 Section Cited CCR 101229 1 2 3 4 5 6 7(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Facility staff left child unattended and unsupervised in the classroom restroom for approximately 10 minutes.1 2 3 4 5 6 7Director states facility will be taking the following steps: (1) Teachers will conduct a head count of children during group activities and/or moving throughout the facility to and from classrooms. (2) Teachers will document the head count and keep a log and submit proof via emai to Licensing Program Analyst Bill Billones at bill.billones@dss.ca.gov 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 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. Ana Tolentino NAME OF LICENSING PROGRAM MANAGER: Bill-Brian Billones NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025

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 April 8, 2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management Incident Inspection at the abovementioned facility. LPA met with Desiree Feller, director, and informed them the purpose of the inspection was to follow up on an incident self reported to the Department on April 3, 2025 as required. LPA was escorted throughout the facility and toured the inside and outside. During the inspection, LPA observed 14 staff and 61 children in care. On April 2, 2025, at approximately 9:00 AM, child 1 was using the restroom located in one of four preschool classrooms and was left unsupervised for approximately 10 minutes during chapel - a group activity with the children and teachers. Staff heard the child and observed that the child was alone in the classroom's restroom. LPA interviewed Director regarding the incident and observed the areas were the incident occurred. LPA interviewed 2 teachers involved in the incident. Based on the information gathered during the inspection, LPA determined that staff took appropriate action in self-reporting the incident. The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind in the restroom. Director states the facility has a plan of action to prevent similar incidences from occurring in the future. During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Notice of site visit was provided, appeal rights were given, and report was reviewed with Director, Desiree Feller. NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025 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: PROVIDENCE PRESCHOOL FACILITY NUMBER: 426215638 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/08/2025 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/22/2025 Section Cited CCR 101229 1 2 3 4 5 6 7(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Facility staff left child unattended and unsupervised in the classroom restroom for approximately 10 minutes.1 2 3 4 5 6 7Director states facility will be taking the following steps: (1) Teachers will conduct a head count of children during group activities and/or moving throughout the facility to and from classrooms. (2) Teachers will document the head count and keep a log and submit proof via emai to Licensing Program Analyst Bill Billones at bill.billones@dss.ca.gov 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 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. Ana Tolentino NAME OF LICENSING PROGRAM MANAGER: Bill-Brian Billones NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025

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 April 8, 2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management Incident Inspection at the abovementioned facility. LPA met with Desiree Feller, director, and informed them the purpose of the inspection was to follow up on an incident self reported to the Department on April 3, 2025 as required. LPA was escorted throughout the facility and toured the inside and outside. During the inspection, LPA observed 14 staff and 61 children in care. On April 2, 2025, at approximately 9:00 AM, child 1 was using the restroom located in one of four preschool classrooms and was left unsupervised for approximately 10 minutes during chapel - a group activity with the children and teachers. Staff heard the child and observed that the child was alone in the classroom's restroom. LPA interviewed Director regarding the incident and observed the areas were the incident occurred. LPA interviewed 2 teachers involved in the incident. Based on the information gathered during the inspection, LPA determined that staff took appropriate action in self-reporting the incident. The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind in the restroom. Director states the facility has a plan of action to prevent similar incidences from occurring in the future. During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Notice of site visit was provided, appeal rights were given, and report was reviewed with Director, Desiree Feller. NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025 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: PROVIDENCE PRESCHOOL FACILITY NUMBER: 426215638 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/08/2025 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/22/2025 Section Cited CCR 101229 1 2 3 4 5 6 7(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Facility staff left child unattended and unsupervised in the classroom restroom for approximately 10 minutes.1 2 3 4 5 6 7Director states facility will be taking the following steps: (1) Teachers will conduct a head count of children during group activities and/or moving throughout the facility to and from classrooms. (2) Teachers will document the head count and keep a log and submit proof via emai to Licensing Program Analyst Bill Billones at bill.billones@dss.ca.gov 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 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. Ana Tolentino NAME OF LICENSING PROGRAM MANAGER: Bill-Brian Billones NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025

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 April 8, 2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management Incident Inspection at the abovementioned facility. LPA met with Desiree Feller, director, and informed them the purpose of the inspection was to follow up on an incident self reported to the Department on April 3, 2025 as required. LPA was escorted throughout the facility and toured the inside and outside. During the inspection, LPA observed 14 staff and 61 children in care. On April 2, 2025, at approximately 9:00 AM, child 1 was using the restroom located in one of four preschool classrooms and was left unsupervised for approximately 10 minutes during chapel - a group activity with the children and teachers. Staff heard the child and observed that the child was alone in the classroom's restroom. LPA interviewed Director regarding the incident and observed the areas were the incident occurred. LPA interviewed 2 teachers involved in the incident. Based on the information gathered during the inspection, LPA determined that staff took appropriate action in self-reporting the incident. The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind in the restroom. Director states the facility has a plan of action to prevent similar incidences from occurring in the future. During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Notice of site visit was provided, appeal rights were given, and report was reviewed with Director, Desiree Feller. NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025 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: PROVIDENCE PRESCHOOL FACILITY NUMBER: 426215638 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/08/2025 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/22/2025 Section Cited CCR 101229 1 2 3 4 5 6 7(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Facility staff left child unattended and unsupervised in the classroom restroom for approximately 10 minutes.1 2 3 4 5 6 7Director states facility will be taking the following steps: (1) Teachers will conduct a head count of children during group activities and/or moving throughout the facility to and from classrooms. (2) Teachers will document the head count and keep a log and submit proof via emai to Licensing Program Analyst Bill Billones at bill.billones@dss.ca.gov 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 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. Ana Tolentino NAME OF LICENSING PROGRAM MANAGER: Bill-Brian Billones NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025

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 April 8, 2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management Incident Inspection at the abovementioned facility. LPA met with Desiree Feller, director, and informed them the purpose of the inspection was to follow up on an incident self reported to the Department on April 3, 2025 as required. LPA was escorted throughout the facility and toured the inside and outside. During the inspection, LPA observed 14 staff and 61 children in care. On April 2, 2025, at approximately 9:00 AM, child 1 was using the restroom located in one of four preschool classrooms and was left unsupervised for approximately 10 minutes during chapel - a group activity with the children and teachers. Staff heard the child and observed that the child was alone in the classroom's restroom. LPA interviewed Director regarding the incident and observed the areas were the incident occurred. LPA interviewed 2 teachers involved in the incident. Based on the information gathered during the inspection, LPA determined that staff took appropriate action in self-reporting the incident. The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind in the restroom. Director states the facility has a plan of action to prevent similar incidences from occurring in the future. During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Notice of site visit was provided, appeal rights were given, and report was reviewed with Director, Desiree Feller. NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025 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: PROVIDENCE PRESCHOOL FACILITY NUMBER: 426215638 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/08/2025 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/22/2025 Section Cited CCR 101229 1 2 3 4 5 6 7(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Facility staff left child unattended and unsupervised in the classroom restroom for approximately 10 minutes.1 2 3 4 5 6 7Director states facility will be taking the following steps: (1) Teachers will conduct a head count of children during group activities and/or moving throughout the facility to and from classrooms. (2) Teachers will document the head count and keep a log and submit proof via emai to Licensing Program Analyst Bill Billones at bill.billones@dss.ca.gov 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 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. Ana Tolentino NAME OF LICENSING PROGRAM MANAGER: Bill-Brian Billones NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025