GIBSON STATE 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 25Licensing Program Analyst (LPA) Lauren Scott and Investigator, Nathan Gonzalez conducted a case management inspection at the facility. LPAs met with Child Development Coordinator, Maria Lewis. At time of arrival LPA's observed 21 children and four staff. Based on interviews with staff and parents, as well as review of facility documentation, the facility did not notify parents immediately of a an injury which was more serious than a minor cut or scratch which poses a potential health, safety or personal rights risk to persons in care. Title 22 deficiencies have been cited on subsequent page, LIC 809D. An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Child Development Coordinator, Maria Lewis. A copy of this report and appeal rights were discussed and left for Director. A Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Chayntel Hunter LICENSING EVALUATOR NAME: Lauren Scott LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024 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: GIBSON STATE PRESCHOOL FACILITY NUMBER: 574500035 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/07/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/08/2024 Section Cited CCR 101226(a) 1 2 3 4 5 6 7(a) The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch…. This requirement was not met as evidenced by:1 2 3 4 5 6 7Facility will conduct a training on reporting requirements, including injuries that are considered more serious that a minor cut or scratch. Director will submit training notes with staff signatures to LPA 8 9 10 11 12 13 14Based on interviews and facility documentation, it was revealed that the facility did not contact parents when the child’s injury became more serious. This is an immediate health and safety risk to children in care.8 9 10 11 12 13 14 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:Chayntel Hunter LICENSING EVALUATOR NAME:Lauren Scott LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024

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) Lauren Scott and Investigator, Nathan Gonzalez conducted a case management inspection at the facility. LPAs met with Child Development Coordinator, Maria Lewis. At time of arrival LPA's observed 21 children and four staff. Based on interviews with staff and parents, as well as review of facility documentation, the facility did not notify parents immediately of a an injury which was more serious than a minor cut or scratch which poses a potential health, safety or personal rights risk to persons in care. Title 22 deficiencies have been cited on subsequent page, LIC 809D. An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Child Development Coordinator, Maria Lewis. A copy of this report and appeal rights were discussed and left for Director. A Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Chayntel Hunter LICENSING EVALUATOR NAME: Lauren Scott LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024 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: GIBSON STATE PRESCHOOL FACILITY NUMBER: 574500035 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/07/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/08/2024 Section Cited CCR 101226(a) 1 2 3 4 5 6 7(a) The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch…. This requirement was not met as evidenced by:1 2 3 4 5 6 7Facility will conduct a training on reporting requirements, including injuries that are considered more serious that a minor cut or scratch. Director will submit training notes with staff signatures to LPA 8 9 10 11 12 13 14Based on interviews and facility documentation, it was revealed that the facility did not contact parents when the child’s injury became more serious. This is an immediate health and safety risk to children in care.8 9 10 11 12 13 14 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:Chayntel Hunter LICENSING EVALUATOR NAME:Lauren Scott LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024

Type B citation - potential risk if not corrected