ROOTS & WINGS FAMILY DEVELOPMENT CENTER

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 07/18/25 at 10:00am , Licensing Program Analyst (LPAs) Brian Fung and Veronica Diaz made an unannounced inspection for the purpose of conducting a Case Management inspection. LPAs met with Beatriz Martinez to discuss an incident that was self-reported to Community Care Licensing Division (CCLD) office by phone on 07/03/25. LPAs toured the area/classroom where the incident occurred and interviewed Director and Staff. On 7/2/25 an incident occurred at the center. At or around time 12:35pm. C1 was left inside the classroom after using the restroom, to whom. Staff (S2) observed the incident. S2 notified S1 that C1 was in the classroom playing with blocks alone. S1 immediately went inside to guide C1 back outside for lunch Parents were contacted at pickup.The child returned to the facility the next day. To prevent any similar incidents, the Director has reinforced and updated their "Keeping children safe: policy and procedures for maintaining accountability for children" contract. Each staff was requested to review, sign, and place back into their personnel file. Given the incident was observed by staff who took appropriate action by reporting to SBRO, because a similar prior incident happened of a child being left inside the classroom alone, a Typ B deficiency is being issued as a result of this incident. Exit interview and review of report was conducted with Beatriz Martinez, appeals rights given, and notice of Site visit was provided and must be posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100. NAME OF LICENSING PROGRAM MANAGER: Susana Martinez NAME OF LICENSING PROGRAM ANALYST: Brian Fung LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2025 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 the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to iss

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 07/18/25 at 10:00am , Licensing Program Analyst (LPAs) Brian Fung and Veronica Diaz made an unannounced inspection for the purpose of conducting a Case Management inspection. LPAs met with Beatriz Martinez to discuss an incident that was self-reported to Community Care Licensing Division (CCLD) office by phone on 07/03/25. LPAs toured the area/classroom where the incident occurred and interviewed Director and Staff. On 7/2/25 an incident occurred at the center. At or around time 12:35pm. C1 was left inside the classroom after using the restroom, to whom. Staff (S2) observed the incident. S2 notified S1 that C1 was in the classroom playing with blocks alone. S1 immediately went inside to guide C1 back outside for lunch Parents were contacted at pickup.The child returned to the facility the next day. To prevent any similar incidents, the Director has reinforced and updated their "Keeping children safe: policy and procedures for maintaining accountability for children" contract. Each staff was requested to review, sign, and place back into their personnel file. Given the incident was observed by staff who took appropriate action by reporting to SBRO, because a similar prior incident happened of a child being left inside the classroom alone, a Typ B deficiency is being issued as a result of this incident. Exit interview and review of report was conducted with Beatriz Martinez, appeals rights given, and notice of Site visit was provided and must be posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100. NAME OF LICENSING PROGRAM MANAGER: Susana Martinez NAME OF LICENSING PROGRAM ANALYST: Brian Fung LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/18/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2025 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 the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given. CIVIL PENALTIES The licensing agency is required by law to iss

Type B citation - potential risk if not corrected