R.L. STEVENS EXTENDED CHILD CARE

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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Amy Strother made an unannounced case management visit to the facility after receiving an Unusual Incident Report (UIR) from the facility on 01/27/25, regarding a student’s, Child 1 (C1’s), inappropriate behavior directed toward another student on 01/24/25. LPA met with Facility Representative and Director, Michelle Dominguez (D1). During today’s visit, 29 students were being supervised by D1 and 4 staff, operating within the licensed capacity and ratio requirements. LPA interviewed D1 and one additional staff, who was present during the incident on 01/24/25, (S1). Based on interviews conducted, staff are helping to mitigate C1’s inappropriate behavior by separating C1 from the student that C1 tends to display inappropriate behavior towards, directing C1 to move to another area of the classroom to engage in a specific activity, giving verbal reminders to C1, and speaking to C1's parent about the behaviors. The facility is following their written policies, which state in summary that a written behavior notice is signed and copy given to students authorized representative, next a Level 1 notice is issued if behavior from behavior notice continues during the next three days with guidance from the Program Director. After Level 1, a Level 2 notice is issued which results in 2 days suspension and/or until a meeting with Program Director and Center Director is held with the students authorized representative. The final level is Level 3, which results in expulsion, after not being able to resolve the continued behavior, going through each level or if the behavior warrants going straight to a Level 3. LPA was directed to the Parent Handbook to review the Child Behavior Policy on Extended Child Care's website. Based on interviews and record review the facility is following the Child Behavior Policy with C1. Continue on PAGE 2 SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025 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: R.L. STEVENS EXTENDED CHILD CAREFACILITY NUMBER: 493000369 VISIT DATE: 02/06/2025 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 32PAGE 2 There were no Title 22 deficiencies cited during today's inspection. This report was reviewed and discussed with Facility Representative, Michelle Dominguez. Appeal Rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Amy Strother made an unannounced case management visit to the facility after receiving an Unusual Incident Report (UIR) from the facility on 01/27/25, regarding a student’s, Child 1 (C1’s), inappropriate behavior directed toward another student on 01/24/25. LPA met with Facility Representative and Director, Michelle Dominguez (D1). During today’s visit, 29 students were being supervised by D1 and 4 staff, operating within the licensed capacity and ratio requirements. LPA interviewed D1 and one additional staff, who was present during the incident on 01/24/25, (S1). Based on interviews conducted, staff are helping to mitigate C1’s inappropriate behavior by separating C1 from the student that C1 tends to display inappropriate behavior towards, directing C1 to move to another area of the classroom to engage in a specific activity, giving verbal reminders to C1, and speaking to C1's parent about the behaviors. The facility is following their written policies, which state in summary that a written behavior notice is signed and copy given to students authorized representative, next a Level 1 notice is issued if behavior from behavior notice continues during the next three days with guidance from the Program Director. After Level 1, a Level 2 notice is issued which results in 2 days suspension and/or until a meeting with Program Director and Center Director is held with the students authorized representative. The final level is Level 3, which results in expulsion, after not being able to resolve the continued behavior, going through each level or if the behavior warrants going straight to a Level 3. LPA was directed to the Parent Handbook to review the Child Behavior Policy on Extended Child Care's website. Based on interviews and record review the facility is following the Child Behavior Policy with C1. Continue on PAGE 2 SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025 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: R.L. STEVENS EXTENDED CHILD CAREFACILITY NUMBER: 493000369 VISIT DATE: 02/06/2025 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 32PAGE 2 There were no Title 22 deficiencies cited during today's inspection. This report was reviewed and discussed with Facility Representative, Michelle Dominguez. Appeal Rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025