ADAMS ELEMENTARY SCHOOL

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 11/18/25, Licensing Program Analyst (LPA) Elvira Sierra met with Facility Representative, Daisy Rodriguez for a case management inspection as a result of receiving an unusual incident report. On 11/17/25 an incident occurred, when a child wandered away from the facility through a gate located in the playground. Child was found by the sidewalk of the school near the facility playground. Immediately following the incident, protocols were followed ensuring that all the doors remain closed and are in good repair. Per State Compliance Specialist, Irene Hettervik a staff training will be held on 11/19/25 on topics of transition and supervision. LPA observed adequate levels of supervision today. Upon arrival present in the facility were 17 children in classroom #1 (State classroom) with 6 staff and 13 children in the Head Start classroom #41 with 3 staff. The attached type A deficiency is cited in the next page LIC 809D. LPA Sierra informed facility representative, Daisy Rodriguez that this report dated 11/18/25 document one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Sierra informed to provide a copy of this licensing report dated 11/18/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224 ), or other written statement, must be placed in the child's file for verification. An exit interview was conducted. Appeal rights were given and discussed. A site visit notice was posted and must remain posted for 30 days. NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman NAME OF LICENSING PROGRAM ANALYST: Elvira Sierra LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2025 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 3 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 th

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 25On 11/18/25, Licensing Program Analyst (LPA) Elvira Sierra met with Facility Representative, Daisy Rodriguez for a case management inspection as a result of receiving an unusual incident report. On 11/17/25 an incident occurred, when a child wandered away from the facility through a gate located in the playground. Child was found by the sidewalk of the school near the facility playground. Immediately following the incident, protocols were followed ensuring that all the doors remain closed and are in good repair. Per State Compliance Specialist, Irene Hettervik a staff training will be held on 11/19/25 on topics of transition and supervision. LPA observed adequate levels of supervision today. Upon arrival present in the facility were 17 children in classroom #1 (State classroom) with 6 staff and 13 children in the Head Start classroom #41 with 3 staff. The attached type A deficiency is cited in the next page LIC 809D. LPA Sierra informed facility representative, Daisy Rodriguez that this report dated 11/18/25 document one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Sierra informed to provide a copy of this licensing report dated 11/18/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224 ), or other written statement, must be placed in the child's file for verification. An exit interview was conducted. Appeal rights were given and discussed. A site visit notice was posted and must remain posted for 30 days. NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman NAME OF LICENSING PROGRAM ANALYST: Elvira Sierra LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2025 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 3 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 th