PULLIAM 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 03/29/23 Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced case management inspection and met with Facility representative, Breanna Fredricksen. Present were three staff supervising 14 children. Program is in compliance with Staff/Child ratios. During the inspection, facility representative and LPA discussed unusual incident occurred on 03/24/23 in which Child #1 wandered outside the classroom due to the classroom door being left opened by Janitorial staff. The child walked himself to the campus office. Facility representative stated that yard duty teacher escorted child back to the classroom a few minute later after noticing child was missing from the classroom. Facility representative stated that was child first day in the program and that there were three staff supervising 11 children at the time of the incident. Facility representative stated that the campus gates leading to the street remained always locked so children are not able to leave the campus grounds. Also the classroom is always locked and only accessible to school employees. Facility representative stated a Staff meeting was held on 03/25/23 to discuss plans for supervision in the classroom and to make sure all staff know and understand that there must be 100% supervision 100% of the time. Child #1 continues to attend program. LPA observed adequate levels of supervision on today's inspection. See attached 809D for deficiency cited. Exit interview conducted and this report and Appeal of Rights were reviewed and provided to facility representative, Breanna Fredrick. Notice of Site Visit posted and should remain posted for 30 days. FOR TYPE A DEFICIENCIES ONLY, upon receipt, facility representative shall post this report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt. (LIC 9224 was provided). SUPERVISORS NAME: Bettina Engelman LICENSING EVALUATOR NAME: Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023 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: PULLIAM SCHOOL FACILITY NUMBER: 390317664 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/29/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 03/30/2023 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7101229 (a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision.....(1) No child(ren) shall be left without the supervision of a teacher at any time..... This requirement was not met as evidence by; 1 2 3 4 5 6 7Facility representative stated that program held a staff meeting regarding proper supervision. Facility representative also stated that she talked to the campus principal regarding janitorial staff not leaving the classroom door open when children are present. Facility representative provided LPA with an agenda of the training attendance held on 03/24/23 on today's inspection. 8 9 10 11 12 13 14Facility representative admitted they were unaware that the child had wandered away from the classroom. This is a violation that if not corrected poses an immediate risk to the children in care.8 9 10 11 12 13 14Deficiency is cleared on today's visit. Civil Penalty of five hunded follars($500.00) will be assess on the next page. 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. SUPERVISOR'S NAME:Bettina Engelman LICENSING EVALUATOR NAME:Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023

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 03/29/23 Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced case management inspection and met with Facility representative, Breanna Fredricksen. Present were three staff supervising 14 children. Program is in compliance with Staff/Child ratios. During the inspection, facility representative and LPA discussed unusual incident occurred on 03/24/23 in which Child #1 wandered outside the classroom due to the classroom door being left opened by Janitorial staff. The child walked himself to the campus office. Facility representative stated that yard duty teacher escorted child back to the classroom a few minute later after noticing child was missing from the classroom. Facility representative stated that was child first day in the program and that there were three staff supervising 11 children at the time of the incident. Facility representative stated that the campus gates leading to the street remained always locked so children are not able to leave the campus grounds. Also the classroom is always locked and only accessible to school employees. Facility representative stated a Staff meeting was held on 03/25/23 to discuss plans for supervision in the classroom and to make sure all staff know and understand that there must be 100% supervision 100% of the time. Child #1 continues to attend program. LPA observed adequate levels of supervision on today's inspection. See attached 809D for deficiency cited. Exit interview conducted and this report and Appeal of Rights were reviewed and provided to facility representative, Breanna Fredrick. Notice of Site Visit posted and should remain posted for 30 days. FOR TYPE A DEFICIENCIES ONLY, upon receipt, facility representative shall post this report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt. (LIC 9224 was provided). SUPERVISORS NAME: Bettina Engelman LICENSING EVALUATOR NAME: Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023 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: PULLIAM SCHOOL FACILITY NUMBER: 390317664 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/29/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 03/30/2023 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7101229 (a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision.....(1) No child(ren) shall be left without the supervision of a teacher at any time..... This requirement was not met as evidence by; 1 2 3 4 5 6 7Facility representative stated that program held a staff meeting regarding proper supervision. Facility representative also stated that she talked to the campus principal regarding janitorial staff not leaving the classroom door open when children are present. Facility representative provided LPA with an agenda of the training attendance held on 03/24/23 on today's inspection. 8 9 10 11 12 13 14Facility representative admitted they were unaware that the child had wandered away from the classroom. This is a violation that if not corrected poses an immediate risk to the children in care.8 9 10 11 12 13 14Deficiency is cleared on today's visit. Civil Penalty of five hunded follars($500.00) will be assess on the next page. 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. SUPERVISOR'S NAME:Bettina Engelman LICENSING EVALUATOR NAME:Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023

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 03/29/23 Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced case management inspection and met with Facility representative, Breanna Fredricksen. Present were three staff supervising 14 children. Program is in compliance with Staff/Child ratios. During the inspection, facility representative and LPA discussed unusual incident occurred on 03/24/23 in which Child #1 wandered outside the classroom due to the classroom door being left opened by Janitorial staff. The child walked himself to the campus office. Facility representative stated that yard duty teacher escorted child back to the classroom a few minute later after noticing child was missing from the classroom. Facility representative stated that was child first day in the program and that there were three staff supervising 11 children at the time of the incident. Facility representative stated that the campus gates leading to the street remained always locked so children are not able to leave the campus grounds. Also the classroom is always locked and only accessible to school employees. Facility representative stated a Staff meeting was held on 03/25/23 to discuss plans for supervision in the classroom and to make sure all staff know and understand that there must be 100% supervision 100% of the time. Child #1 continues to attend program. LPA observed adequate levels of supervision on today's inspection. See attached 809D for deficiency cited. Exit interview conducted and this report and Appeal of Rights were reviewed and provided to facility representative, Breanna Fredrick. Notice of Site Visit posted and should remain posted for 30 days. FOR TYPE A DEFICIENCIES ONLY, upon receipt, facility representative shall post this report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt. (LIC 9224 was provided). SUPERVISORS NAME: Bettina Engelman LICENSING EVALUATOR NAME: Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023 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: PULLIAM SCHOOL FACILITY NUMBER: 390317664 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/29/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 03/30/2023 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7101229 (a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision.....(1) No child(ren) shall be left without the supervision of a teacher at any time..... This requirement was not met as evidence by; 1 2 3 4 5 6 7Facility representative stated that program held a staff meeting regarding proper supervision. Facility representative also stated that she talked to the campus principal regarding janitorial staff not leaving the classroom door open when children are present. Facility representative provided LPA with an agenda of the training attendance held on 03/24/23 on today's inspection. 8 9 10 11 12 13 14Facility representative admitted they were unaware that the child had wandered away from the classroom. This is a violation that if not corrected poses an immediate risk to the children in care.8 9 10 11 12 13 14Deficiency is cleared on today's visit. Civil Penalty of five hunded follars($500.00) will be assess on the next page. 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. SUPERVISOR'S NAME:Bettina Engelman LICENSING EVALUATOR NAME:Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023

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 03/29/23 Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced case management inspection and met with Facility representative, Breanna Fredricksen. Present were three staff supervising 14 children. Program is in compliance with Staff/Child ratios. During the inspection, facility representative and LPA discussed unusual incident occurred on 03/24/23 in which Child #1 wandered outside the classroom due to the classroom door being left opened by Janitorial staff. The child walked himself to the campus office. Facility representative stated that yard duty teacher escorted child back to the classroom a few minute later after noticing child was missing from the classroom. Facility representative stated that was child first day in the program and that there were three staff supervising 11 children at the time of the incident. Facility representative stated that the campus gates leading to the street remained always locked so children are not able to leave the campus grounds. Also the classroom is always locked and only accessible to school employees. Facility representative stated a Staff meeting was held on 03/25/23 to discuss plans for supervision in the classroom and to make sure all staff know and understand that there must be 100% supervision 100% of the time. Child #1 continues to attend program. LPA observed adequate levels of supervision on today's inspection. See attached 809D for deficiency cited. Exit interview conducted and this report and Appeal of Rights were reviewed and provided to facility representative, Breanna Fredrick. Notice of Site Visit posted and should remain posted for 30 days. FOR TYPE A DEFICIENCIES ONLY, upon receipt, facility representative shall post this report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt. (LIC 9224 was provided). SUPERVISORS NAME: Bettina Engelman LICENSING EVALUATOR NAME: Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023 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: PULLIAM SCHOOL FACILITY NUMBER: 390317664 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/29/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 03/30/2023 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7101229 (a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision.....(1) No child(ren) shall be left without the supervision of a teacher at any time..... This requirement was not met as evidence by; 1 2 3 4 5 6 7Facility representative stated that program held a staff meeting regarding proper supervision. Facility representative also stated that she talked to the campus principal regarding janitorial staff not leaving the classroom door open when children are present. Facility representative provided LPA with an agenda of the training attendance held on 03/24/23 on today's inspection. 8 9 10 11 12 13 14Facility representative admitted they were unaware that the child had wandered away from the classroom. This is a violation that if not corrected poses an immediate risk to the children in care.8 9 10 11 12 13 14Deficiency is cleared on today's visit. Civil Penalty of five hunded follars($500.00) will be assess on the next page. 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. SUPERVISOR'S NAME:Bettina Engelman LICENSING EVALUATOR NAME:Elvira Sierra LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023

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

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