BROOKSIDE 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 25A Case Management visit was conducted at the facility by Licensing Program Analyst (LPA) Robert Maciel in response to a self-reported Unusual Incident Report received by the department on 05/23/25 regarding a child (C1) who was left on the playground during transition inside. LPA met with Site Supervisor Chelsea Rodriguez (D1). According to the incident report and interviews conducted, at around 1:35 PM on May 23, 2025, facility staff were transitioning children from the outdoor playground to the classroom. Staff counted 8 children in total and had them line up to prepare to go inside the classroom. While in line, there was an altercation between two children which drew the attention of staff and, during this time, another child (C1) in the back of the line returned to the playground. After staff and children had entered the classroom, staff noticed there was a child missing and began recounting to verify. A teacher from the NCO Head Start facility (#230111196) observed the child in the playground and returned them to the classroom. D1 stated that the child was outside for less than 2 minutes. D1 stated that staff will now perform a second head count during transition after children line up to prevent this situation from occurring again. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal rights were provided. Report was reviewed and read to the Site Supervisor Chelsea Rodriguez. A notice of site visit was given and must remain posted for 30 days. Failure to do so shall result in an immediate civil penalty of $100. NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin NAME OF LICENSING PROGRAM ANALYST: Robert Maciel LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025 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 i

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25A Case Management visit was conducted at the facility by Licensing Program Analyst (LPA) Robert Maciel in response to a self-reported Unusual Incident Report received by the department on 05/23/25 regarding a child (C1) who was left on the playground during transition inside. LPA met with Site Supervisor Chelsea Rodriguez (D1). According to the incident report and interviews conducted, at around 1:35 PM on May 23, 2025, facility staff were transitioning children from the outdoor playground to the classroom. Staff counted 8 children in total and had them line up to prepare to go inside the classroom. While in line, there was an altercation between two children which drew the attention of staff and, during this time, another child (C1) in the back of the line returned to the playground. After staff and children had entered the classroom, staff noticed there was a child missing and began recounting to verify. A teacher from the NCO Head Start facility (#230111196) observed the child in the playground and returned them to the classroom. D1 stated that the child was outside for less than 2 minutes. D1 stated that staff will now perform a second head count during transition after children line up to prevent this situation from occurring again. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal rights were provided. Report was reviewed and read to the Site Supervisor Chelsea Rodriguez. A notice of site visit was given and must remain posted for 30 days. Failure to do so shall result in an immediate civil penalty of $100. NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin NAME OF LICENSING PROGRAM ANALYST: Robert Maciel LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025 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 i

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 25A Case Management visit was conducted at the facility by Licensing Program Analyst (LPA) Robert Maciel in response to a self-reported Unusual Incident Report received by the department on 05/23/25 regarding a child (C1) who was left on the playground during transition inside. LPA met with Site Supervisor Chelsea Rodriguez (D1). According to the incident report and interviews conducted, at around 1:35 PM on May 23, 2025, facility staff were transitioning children from the outdoor playground to the classroom. Staff counted 8 children in total and had them line up to prepare to go inside the classroom. While in line, there was an altercation between two children which drew the attention of staff and, during this time, another child (C1) in the back of the line returned to the playground. After staff and children had entered the classroom, staff noticed there was a child missing and began recounting to verify. A teacher from the NCO Head Start facility (#230111196) observed the child in the playground and returned them to the classroom. D1 stated that the child was outside for less than 2 minutes. D1 stated that staff will now perform a second head count during transition after children line up to prevent this situation from occurring again. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal rights were provided. Report was reviewed and read to the Site Supervisor Chelsea Rodriguez. A notice of site visit was given and must remain posted for 30 days. Failure to do so shall result in an immediate civil penalty of $100. NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin NAME OF LICENSING PROGRAM ANALYST: Robert Maciel LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025 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 i

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25A Case Management visit was conducted at the facility by Licensing Program Analyst (LPA) Robert Maciel in response to a self-reported Unusual Incident Report received by the department on 05/23/25 regarding a child (C1) who was left on the playground during transition inside. LPA met with Site Supervisor Chelsea Rodriguez (D1). According to the incident report and interviews conducted, at around 1:35 PM on May 23, 2025, facility staff were transitioning children from the outdoor playground to the classroom. Staff counted 8 children in total and had them line up to prepare to go inside the classroom. While in line, there was an altercation between two children which drew the attention of staff and, during this time, another child (C1) in the back of the line returned to the playground. After staff and children had entered the classroom, staff noticed there was a child missing and began recounting to verify. A teacher from the NCO Head Start facility (#230111196) observed the child in the playground and returned them to the classroom. D1 stated that the child was outside for less than 2 minutes. D1 stated that staff will now perform a second head count during transition after children line up to prevent this situation from occurring again. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal rights were provided. Report was reviewed and read to the Site Supervisor Chelsea Rodriguez. A notice of site visit was given and must remain posted for 30 days. Failure to do so shall result in an immediate civil penalty of $100. NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin NAME OF LICENSING PROGRAM ANALYST: Robert Maciel LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025 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 i