Bethlehem Lutheran Church and School

This statement of deficiencies was generated as a result of a semi annual inspection conducted at your facility on 5.5.26. The facility is licensed for 45 as a child care center. The census at the time of inspection were 21 children. 0 staff files and 0 child files were reviewed at the time of inspection, files will be reviewed at the annual inspection. NAC 414 1. A carpeted floor or rug on a floor that is NAC 414 Carpets were cleaned on 5/16/2026 by 05/16/202 too large to wash in a washing machine school maintenance, see attached receipt. 6 must be vacuumed not less than one time The actions Basedon observation, interview and record review on 5.5.26, verification that carpetedfloors/rugs too large for washing were not cleaned once every three months wasnot available at time of inspection. The last documented carpet cleaning was on 11.26.25. Please ensure the cleaning of carpets and rugs occurs at least every 3 months

This statement of deficiencies was generated as a result of an annual and health inspection conducted at your facility on 10.21.24. The facility is licensed for 45 as a child care center. The census at the time of inspection were 22 children. 10 child files and 5 staff files were reviewed. General Reminder for the following staff to complete their trainings: -2 hours of child wellness for: Ashlynd B, Honey Lynn T, and Debra W. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROV Based on observation and record review on 12.5.25, facility failed to ensure child # 6 had a signed permission to release information form. Please gather and file. NAC.370 1. Evidence of each child ' s health must be NAC.370 Parent resubmitted her child's medical form. 12/15/202 presented to the director of a facility, other 5 than an accommodation facility or a facility that provides care for ill children, within 30 days after the child ' s initial admission. The evidence must include a written statement from a licensed physician or registered nurse attesting to the status of the child ' s h Based on observation and record review on 12.5.25, facility failed to ensure child #2 had a signed health statement. Please gather and file.

This statement of deficiencies was generated as a result of an annual inspection conducted at your facility on 4.8.25. The facility is licensed for 45 children as a child care center. The census at the time of inspection was 22 children. 0 child files and 0 staff files were reviewed, files will be reviewed at annual inspection. Licensing reminders and recommendations: • Implement routine checks of play equipment to ensure play area is free of hazards • Ensure personal items are stored accordingly • Carpet cleaning due by end of April If deficiencies are cited, an approved plan of correction m

This statement of deficiencies was generated as a result of an annual inspection conducted at your facility on 11.1.24. The facility is licensed for 45 as a child care center. The census at the time of inspection was 22 children. 10 child files and 7 staff files were reviewed. There were no regulatory deficiencies at the time of inspection, however, please review the important reminders and recommendations. Reminders and Recommendations': Staff #1: Follow up with Backgrounds on recent C&R Staff #7: Initial trainings are due 12-16-24 and must apply to Nevada Registry by 11- 16-24 - Upload requ

This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/6/24.The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 18. 15 children’s files were reviewed and 7 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Rake resilient surface to ensure even distribution -Staff #1 Nevada Registry expires 5/11/24; Staff #3 Nevada Registry expires 5/18/24; Staff #5 needs to renew Nevada Registry prior to return to work from leave If defi

This Statement of Deficiencies was generated as a result of an annual inspection on 11/7/23. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 24. 15 children’s files were reviewed and 8 employee files were reviewed. Reminders and Recommendations: -Rake resilient surface to evenly distribute -Fire drill due this month -Staff #8 needs to apply to Nevada If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name Based on interview and record review on 11/7/23 facility failed to abide by background check procedures. Proper procedures for required background investigation must be followed. The following staff was hired with no record or being entered into NABS: -Staff #8 hire date 8/29/23 NAC 323 1. Except as otherwise provided in NAC NAC 323 Staff #2 and Staff#3 have completed the 11/13/202 432A.521 and NRS 432A.177, within 120 Recognizing and Reporting Child abuse 3 days after commencing his or her class as of 11/13/23. The director is employment or position in a child care responsible for making sure all classes are facility, each person who is employed in a done and we are incompliance. The director child care facility, other than a person uses a checkoff sheet to ensure all staff are employed i... Based on interview and record review on 11/7/23,the facility failed to ensure that within 120 days of hire each employee completed the required hours of training in child care which includes: any training required by the facility for the purposes of obtaining certification in CPR, three or more hours of training in child development , two or more hours of training in first aid, two or more hours of training in the signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodbourne pathogens, two or more hours of training in the recognit

This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/11/23. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 15. 15 children’s files were reviewed and 10 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Update/upload NABS by 5/12/23 as discussed -Rake resilient surface to evenly distribute -Staff #2 needs Child Abuse by 6/29/23; Staff #3 Nevada Registry expires 5/18/23 and needs Child Abuse by 6/27/23 If deficienci This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/11/23. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 15. 15 children’s files were reviewed and 10 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Update/upload NABS by 5/12/23 as discussed -Rake resilient surface to evenly FORM APPROVED Division of Pudbilsict raibnudt eBehavioral Health

This statement of deficiencies was generated as a result of an annual inspection conducted on 11.8.22 at your facility. The facility is licensed for 45 children as a child care center. The census as the time of inspection was 20 children and 4 staff. 15 children's files and 9 staff files were reviewed. Child Care Licensing Reminders: -All renewal application documents must be uploaded for review prior to 12.23.22 for timely review and submission. -Staff #5: 1 annual training hour -Staff #6: 4 annual training hours If deficiencies are cited, an approved plan of correction must be returned with Based on record review and interview on 11.8.22, facility did not ensure that information provided by the parent before admission included a written authorization signed by a parent which allows for emergency and medical care. Secure missing information for the children as listed below. Director states program is now utilizing new online admission system which has a "yes/no" option for emergency medical care. The following children have "no" marked for emergency medical care. -Child #8 -Child #11 -Child #12 NRS 178 Child care facility required to maintain NRS 178 child #7 Has had his file rev Based on record 727 B. WING _______________________ 11/08/2022 BETHLEHEM LUTHERAN CHURCH AND SCHOOL 1837 N. MOUNTAIN STREET, CARSON CITY, NEVADA ,89703

This statement of deficiencies was generated as a result of a semi annual survey conducted at your facility. The facility is licensed for 45 children as a child care facility. The census at the time of inspection was 26 children. 15 children's files and 8 staff files were reviewed. Reminders: -Snack menu discussed with director. Parents provide snacks, facility provides back ups. Director states due to supply shortages, some items are hard to find. Surveyor reminded director that menu must follow CAFCP and document changes when food options are unavailable. If deficiencies are cited, an appro Based on observation and interview on 5.10.22, playground equipment was not in good repair as evidenced by the following: -Threshold of plastic school playhouse presents tripping hazard. Remove or repair broken section. 727 B. WING _______________________ 05/10/2022 NAME OF PROVI Based on observation and interview on 5.10.22, facility failed to recognize and eliminate the following hazards for the safety of children as evidenced by the following: -Alka Seltzer used in a project earlier in the day left unattended on top of a staff purse. -Can of cleaning powder and plastic bags present under sink in Latchkey room without a child lock present. -Outlet covers not present in classrooms. *Director moved Alka Seltzer, can of cleaning powder, and plastic bags out of reach of children while Surveyor on site. NAC 340 1. Procedures for admission must provide NAC 340 We are chan Based on record review and interview on 5.10.22, facility did not ensure that information provided by the parent before admission included a written authorization signed by parent which allows emergency and medical care. Director states that child admission forms were recently updated to be electronic. Upon child file review surveyors noted that the section for emergency medical care is a "yes" or "no" option and some parents select "no". Secure missing authoriation for the children as noted below. -child 3 -child 7 -child 11 Based on observation, interview, and record review on 5.10.22, faci Based on record review on 5.10.22, facility failed to ensure assessments were completed at least twice a year and within 3 months of enrollment. Please ensure assessents are completed for children as listed: -Child #2 NAC 416 1. Each member of the staff of a facility that NAC 416 As of 5-31-22, 15 Nap Mats have been 08/30/202 is necessary to meet the applicable thrown away and new ones have been 2 requirement for the ratio of caregivers to ordered this was completed by HoneyLynne children set forth in Based on observation and interview on 5.10.22, facility failed to ensure each sleeping device has a waterproof covering. Numerous nap mats stored in latchkey room were torn/split.

This Statement of Deficiencies was generated as a result of an annual inspection on 11/15/21. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 8. 4 children’s files were reviewed and 5 employee files were reviewed. Reminders and Recommendations: -Email backgrounds to request clearance memos for staff under 18 and upload clearance memo and consent and release for staff #4 by 11/17/21 -Fire drill due this month -Rake sand area to ensure even distribution and appropriate depths of resilient surface -Staff #2 and Staff #3 need to apply to

This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/10/21. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 17. 4 children’s files were reviewed and 5 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Fire drill due this month -Staff #5 Nevada Registry expires 5/18/21 -Rake resilient surface to evenly distribute and ensure appropriate depths are maintained If deficiencies are cited, an approved plan of correction m

This statement of deficiencies was generated as a result of an annual and health inspection conducted at your facility on 10.21.24. The facility is licensed for 45 as a child care center. The census at the time of inspection were 22 children. 10 child files and 5 staff files were reviewed. General Reminder for the following staff to complete their trainings: -2 hours of child wellness for: Ashlynd B, Honey Lynn T, and Debra W. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROV Based on observation and record review on 12.5.25, facility failed to ensure child # 6 had a signed permission to release information form. Please gather and file. NAC.370 1. Evidence of each child ' s health must be NAC.370 Parent resubmitted her child's medical form. 12/15/202 presented to the director of a facility, other 5 than an accommodation facility or a facility that provides care for ill children, within 30 days after the child ' s initial admission. The evidence must include a written statement from a licensed physician or registered nurse attesting to the status of the child ' s h Based on observation and record review on 12.5.25, facility failed to ensure child #2 had a signed health statement. Please gather and file.

This statement of deficiencies was generated as a result of an annual inspection conducted at your facility on 4.8.25. The facility is licensed for 45 children as a child care center. The census at the time of inspection was 22 children. 0 child files and 0 staff files were reviewed, files will be reviewed at annual inspection. Licensing reminders and recommendations: • Implement routine checks of play equipment to ensure play area is free of hazards • Ensure personal items are stored accordingly • Carpet cleaning due by end of April If deficiencies are cited, an approved plan of correction m

This statement of deficiencies was generated as a result of an annual inspection conducted at your facility on 11.1.24. The facility is licensed for 45 as a child care center. The census at the time of inspection was 22 children. 10 child files and 7 staff files were reviewed. There were no regulatory deficiencies at the time of inspection, however, please review the important reminders and recommendations. Reminders and Recommendations': Staff #1: Follow up with Backgrounds on recent C&R Staff #7: Initial trainings are due 12-16-24 and must apply to Nevada Registry by 11- 16-24 - Upload requ

This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/6/24.The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 18. 15 children’s files were reviewed and 7 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Rake resilient surface to ensure even distribution -Staff #1 Nevada Registry expires 5/11/24; Staff #3 Nevada Registry expires 5/18/24; Staff #5 needs to renew Nevada Registry prior to return to work from leave If defi

This Statement of Deficiencies was generated as a result of an annual inspection on 11/7/23. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 24. 15 children’s files were reviewed and 8 employee files were reviewed. Reminders and Recommendations: -Rake resilient surface to evenly distribute -Fire drill due this month -Staff #8 needs to apply to Nevada If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name Based on interview and record review on 11/7/23 facility failed to abide by background check procedures. Proper procedures for required background investigation must be followed. The following staff was hired with no record or being entered into NABS: -Staff #8 hire date 8/29/23 NAC 323 1. Except as otherwise provided in NAC NAC 323 Staff #2 and Staff#3 have completed the 11/13/202 432A.521 and NRS 432A.177, within 120 Recognizing and Reporting Child abuse 3 days after commencing his or her class as of 11/13/23. The director is employment or position in a child care responsible for making sure all classes are facility, each person who is employed in a done and we are incompliance. The director child care facility, other than a person uses a checkoff sheet to ensure all staff are employed i... Based on interview and record review on 11/7/23,the facility failed to ensure that within 120 days of hire each employee completed the required hours of training in child care which includes: any training required by the facility for the purposes of obtaining certification in CPR, three or more hours of training in child development , two or more hours of training in first aid, two or more hours of training in the signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodbourne pathogens, two or more hours of training in the recognit

This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/11/23. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 15. 15 children’s files were reviewed and 10 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Update/upload NABS by 5/12/23 as discussed -Rake resilient surface to evenly distribute -Staff #2 needs Child Abuse by 6/29/23; Staff #3 Nevada Registry expires 5/18/23 and needs Child Abuse by 6/27/23 If deficienci This Statement of Deficiencies was generated as a result of a semi- annual inspection on 5/11/23. The facility is licensed for 45 children as a Child Care facility. The census at the time of the survey was 15. 15 children’s files were reviewed and 10 employee files were reviewed. There were no regulatory deficiencies noted at the time of inspection. Reminders and Recommendations: -Update/upload NABS by 5/12/23 as discussed -Rake resilient surface to evenly FORM APPROVED Division of Pudbilsict raibnudt eBehavioral Health

This statement of deficiencies was generated as a result of an annual inspection conducted on 11.8.22 at your facility. The facility is licensed for 45 children as a child care center. The census as the time of inspection was 20 children and 4 staff. 15 children's files and 9 staff files were reviewed. Child Care Licensing Reminders: -All renewal application documents must be uploaded for review prior to 12.23.22 for timely review and submission. -Staff #5: 1 annual training hour -Staff #6: 4 annual training hours If deficiencies are cited, an approved plan of correction must be returned with Based on record review and interview on 11.8.22, facility did not ensure that information provided by the parent before admission included a written authorization signed by a parent which allows for emergency and medical care. Secure missing information for the children as listed below. Director states program is now utilizing new online admission system which has a "yes/no" option for emergency medical care. The following children have "no" marked for emergency medical care. -Child #8 -Child #11 -Child #12 NRS 178 Child care facility required to maintain NRS 178 child #7 Has had his file rev Based on record 727 B. WING _______________________ 11/08/2022 BETHLEHEM LUTHERAN CHURCH AND SCHOOL 1837 N. MOUNTAIN STREET, CARSON CITY, NEVADA ,89703