Capstone Christian Academy

This Statement of Deficiencies was generated as a result of the on-site State licensure inspection conducted at your facility on 12/15/2025 Please respond to each deficiency and attach documents as requested for the deficiency it pertains to. Sign and submit your Plan of Correction within 10 business days of receipt. Inspection consensus, the facility is licensed for 48 children as a Center. The census at the time of survey was 36 children. 10 children's files and 11 staff files were reviewed. Based on observation , the playground had the following hazards: - The wooden post holding up the ropes along the side of the playground were observed splinting and will need to be sanded/ resurface to eliminate splinting hazards. Complete corrections and upload pictures to provide proof of these corrections.

The facility is licensed for 72 children as a Center. The census at the time of inspection was 34 children. 0 child's file and 2 staff files were reviewed. Reminders: Ensure all adults scissors are stored locked or inaccessible to children. It should be noted that adult scissors were observed in reach in classrooms 4 and 5. It should be noted that these hazards were corrected on site. Ensure cots are not stacked high in classrooms to prevent cots from being a potential falling hazard. It should be noted that this hazard was corrected. All cots were relocated o storage closets in classroom 4 a

The facility is licensed for 136 children as a Center. The census at the time of inspection was 32 children. 10 child's file and 13 staff files were reviewed. NAC 302 1. A licensee of a child care facility shall not NAC 302 12/19/202 knowingly appoint a person as director of NAC 302 4 the facility or appoint or permit the appointment of a person as an employee or Broom volunteer at the facility if the person has 1. The specific actions that will be taken been convicted of child abuse or neglect or to correct the deficiency and verification any other crime involving physical harm to a of compl Based on UNACCEPTABLE PLAN OF observation, the following hazards were CORRECTION Director/Tracy Orban observed during your facility's walkthrough inspection: NAC 302 : -Classroom 5 and 6 Personal items were Playground equipment unlocked and accessible to children. 1. The specific actions that will be taken Hazards were corrected on site. Ensure that to correct the deficiency and verification all classroom closets are utilized for of completion, i.e. documents, personal items, doors are locked when not photographs, etc. (MUST ADDRESS) in use, and closet keys are not left in doors. Director rem

The facility is licensed for 136 children as a Center .The census at the time of inspection was 28 children. 10 child files and 17 staff files were reviewed. 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: TRACY ORBAN Title: Director Date: 08/23/2024 REPRESENTATIVE'S SIGNATURE Based on files review, staff members Keilani Lowe and Ashley Hofer were not added to NABS Roster (Consent and Release forms and Fingerprints were completed). Please add Keilani Lowe and Ashley Hofer to NABS Roster. 3113 B. WING _______________________ 08/13/2024 NAME OF PROVIDE Based on file review to state marshal on 8/22/24 and observation, State Fire Marshal 3. Changes that will be made or measures Certificate of Compliance expired that will be taken to prevent future 1/24/2024. occurrence of the deficient practice (MUST ADDRESS) Director added fire compliance The Certificate of Occupancy from Clark to monthly audit to ensure it is up to date County Building Department that was which is signed once audit is conducted. provided is not the correct certificate See attached audit form document needed for this requirement. 4. Identify the person responsible (MUST ADDR Based on observation, Preschool playground had 3113 B. WING _______________________ 08/13/2024 CAPSTONE CHRISTIAN ACADEMY 985 E SERENE AVE, LAS VEGAS, NEVADA ,89123 a shovel, wheel barrel broom, approximately three garbage cans and one knocked down, items/ boxesoutside of large storage container on right side of playground. Director reported that staff does not allow children onthe side of playground at this time and that the facility is working to get playgroundcleared. Although left side of playground is cleared from hazards and potentially harmful objects, there are no barriers in place to block off and prevent children from access the right side of playground; therefore, this poses as a potential risk. The broom, wheel barrel, and shovel will need to be removed from playground. Garbage... Based on interview, Director reported that Rooms 7 and 8 are no 3113 B. WING _______________________ 08/13/2024 CAPSTONE CHRISTIAN ACADEMY 985 E SERENE AVE, LAS VEGAS, NEVADA ,89123 Based on file review, staff, Ashley Hofer did not have a TB test on file. Ashley Hofer cannot return to facility until negative TB test result are provided. Please upload Ashley Hofer TB test results. 3113 B. WING _______________________ 08/13/2024 Based on file review Child #1, Child #4, Child#5, and Child #8 are missing up-to-date immunizations. Obtain up-to date immunization records and upload. NAC 430 1. Each facility, including, without limitation, NAC 430 1. The specific actions that will be taken to 08/14/202 a family home and a group home, shall correct the deficiency and verification of 4 have an early care and education program. completion, i.e.-documents, photographs, 2. Each facility described in subsection 1 etc. (MUST ADDRESS) Director retrieved shall develop a written assessment plan assessments from child #1, #3, #6, and Based on file review, Child #1 Child #3, Child #6, and Child #10 are needing up-to-date assessments completed. Please completed assessments for the children listed and upload. Please note that child assessments are to be completed within three months of enrollment and every 6 months following. Based on observation, Keilani Lowe was observed working with children alone without having an Eligibility Clarence Memo on file. Director Tracy stepped in immediately and filled in as caregiver for the classroom until second classroom teacher returned from lunch who was cleared / Eligible to work in the classroom. Please note that staff without Eligibility Clearance Memo/ has and "In process" status are not to be left alone with children at any time and will need to be supervised/ work in a classroom with an eligible staff member.

The facility is licensed for 136 children as a Center. The census at the time of investigation was 34 children. 25 children's files and 15 staff files were reviewed. Continue to upload documents into Renewal Application. NAC 340 1. Procedures for admission must provide NAC 340 the caregiver with sufficient information and POC-Capstone 3113-23 NAC instruction from the parents to enable the 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: TRACY ORBAN Title: Based on record review, Child #21 needs Consent for Medical form completed and signed by Parent. Upload signed form then place in 4. Identify the person responsible (MUST child file. ADDRESS) Director (Tracy Orban) as well as the admissionsadministrator (Teri Copas) NRS 178 Child care facility required to maintain NRS 178 Based on record 3113 B. WING _______________________ 12/12/2023 CAPSTONE CHRISTIAN ACADEMY 985 E SERENE AVE, LAS VEGAS, NEVADA ,89123 I Based on record completed. (MUST COMPLETE) review, Child #5,6 and 21 need Permission to Release form signed by Parent. Upload Corrected action 12/21/22 signed form then place in child file. 3. Changes that will be made or measures that will be taken to prevent future occurrenceof the deficient practice (MUST ADDRESS) Director- will create a system that includes checkingstudent files and ensuring they are up to date. Furthermore, prior to a child’senrollment the parents will need to drop off paperwork and will be reviewed toensure it is complete before the student first day of school. 4. Ident Based on record review, Child #22 needs Health Statement signed by Doctor. Upload Health Statement 2. The date the corrective action will be then place in child file. completed. (MUST COMPLETE) Corrected action 12/21/22 3. Changes that will be made or measures that will be taken to prevent future occurrence of the deficient practice (MUST ADDRESS) Director- will create a system that includes checking student files and ensuring they are up to date. Furthermore, prior to a child’s enrollment the parents will need to drop off paperwork and will be reviewed to ensure it is complete before the stu Based on record review, Child #7,8,14,15,17,19 and 21 need updated immunizations. Upload current shot record then place in child file.

Reminder: Facility utilizing less classrooms since more Elementary rooms now and Surveyor informed to submit an Amendment if want to lower capacity. 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: TRACY ORBAN Title: Director Date: 08/18/2023 REPRESENTATIVE'S SIGNATURE Based on record Director (Tracy Orban) as well as the review, Child #11,13 and 21 need admissionsadministrator (Teri Copas) Emergency Medical Form signed by Parent. Upload signed form then place in child file. NRS 230 NRS 230 08/10/202 3 3113 B. WING _______________________ 07/2 Based on record review, Child #3,8,9,10 and 23 need 4 year old shots (5th DTAP, 4th Polio, 2nd MMR and 2nd Varicella). Upload current immunizations then place in child file.

The facility is licensed for 136 children as a Center. The census at the time of inspection was 35 children. 25 children's files and 13 staff files were reviewed. 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: Title: Date: REPRESENTATIVE'S SIGNATURE

The extinguisher tags The director will put in place a monthly expired on 6/4/22, have the extinguisher compliance audit which will include fire retagged and upload the new tag in the plan extinguisher tags. This will also ensure of correction (POC) by 8/12/22. expiration dates and compliance issues are addressed immediately and up to date. The Preschool Director (Tracy Orban (Kessler)

License Capacity 85 Facility Type Center Total number of children 25 Child Files reviewed 3 Staff Files reviewed 10 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: Title: Date: REPRESENTATIVE'S SIGNATURE