Christ the Servant Lutheran Preschool

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 03/30/2026. The facility is licensed for 42 Children as a Center. The census at the time of the survey were 4 children and 2 staff. Files were not reviewed during this inspection visit but will be reviewed at the next inspection. Reminder: Room 1 please repair broken cabinet handle on cabinet under sink. 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

The facility is licensed for 42 children as a Center. The census at the time of inspection was 4 children. 4 child's files and 2 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 facility is licensed for 42 children as a Center. The census at the time of inspection was 8 children. 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

This Statement of Deficiencies wasgenerated as a result of the on-site State licensure survey conducted at yourfacility on 9/5/2024. Please respond toeach deficiency and attach documents as requested for the deficiency itpertains to. Sign and submit your Planof Correction within 10 business days of receipt. Inspection consensus, thefacility is licensed for 40 children as a center. 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: JULIE GILMER Title: Director Date: 09/16/2024 REPRESENTATIVE'S SIGNATURE 369 B. WING _______________________ 09/05/2024 CHRIST THE SERVANT LUTHERAN PRESCHOOL 2 S. PECOS RD, HENDERSON, NEVADA ,89074 The census at thetime of surve... Based on observation and record review on 9/5/2024, parent was not informed of right to view complaints made against facility. Ensure parents sign NRS 178 notification form and it is kept in the child's file. Facility failed to have signed copy of form notifying parents of right to request complaint information for the following children as referenced on the identifier sheet: Child # 1-8 NRS 230 NRS 230 1. Both parents were informed and asked to 09/09/202 bring in updated immunization records 4 Division Based on interview and record review, child(ren) as noted below failed to have current immunization records on file at time of inspection. Please submit a copy of the current immunization record for child(ren) noted below: Child #4 and #7: missing 4 yr. old shots (1 round of DTP, Polio, MMR, and Varicella). Each record should show 5 rounds of DTP, 4 rounds of Polio, and 2 rounds of MMR and Varicella).

This Statement of deficiencies was generated as a result of the onsite State licensure inspection conducted on 02/20/2024. There were no regulatory deficiencies observed at the inspection. This facility is licensed for 42 children as a center. The census at the time of inspection was 6 children. 10 child files and 3 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

ThisStatement of Deficiencies was generated as a result of the on-site Statelicensure survey conducted at your facility on 08/31/2023.. There were no regulatory deficienciesidentified at the time of the survey. The Facility is licensed for 42 children as a center.The census at the time of survey was 5 children. 11 children's files and 3 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 STATE

ThisStatement of Deficiencies was generated as a result of the on-site Statelicensure survey conducted at your facility on 369. Please respond to each deficiency and attachdocuments as requested for the deficiency it pertains to. Sign and submit your Plan of Correctionwithin 10 business days of receipt. Inspection consensus,the facility is licensed for 40 children as a center. The census atthe time of survey was 15 children. 10 children's files and 4 staff fileswere reviewed NRS 230 NRS 230 1. Child #1 has a doctor appointment on 04/05/202 If deficiencies are cited, an approved plan of correc Basedon interview and record review, child(ren) as noted below failed to havecurrent immunization records on file at time of inspection. Please submit acopy of the current immunization record for child(ren) noted below: Child #1: missing 4 yr old shots ( 1 round of DTP, Polio, MMR and Varicella)

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 9/8/2022. 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 42 children as a center. The census at the time of survey was 15 children. 15 children's files and 4 staff files were reviewed. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of Based on interview and record review, child(ren) as noted below failed to have current immunization records on file at time of inspection. Please submit a copy of the current immunization record for child(ren) noted below: Child #1 missing 4 yr. old shots,1 round of DTP, Polio, MMR and Varicella needed. Please upload copy of current record to Plan of Correction once received.

*This Statement ofDeficiencies was generated as a result of the on-site State licensure surveyconducted at your facility on 2/28/22. There were no regulatory deficienciesidentified at the time of the survey. The facility is licensed for 42 children as a center. The census at the time of survey was 12 children. 3 children’s files and 3 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 STATE F

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 09/16/21. *Surveyor McMahan talked with facility director about excellent NABS Roster. Surveyor went over COVID-19 Operating Facility Checklist and gave facility Integration of NAC Codes with Covid Guidelines handout. Reminders: - Evacuation Map needed at rear exit in Classroom 1. - Ms. Julee and Ms. Kelly need Orientation Checklist on file from original start date. - Ensure staff use gloves to serve food with pre-packaged and fresh items. 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: KELLY EVERLY Title: Preschool Director Date... Based on inspection, the facility was found to have hazards as listed below. Facilities will ensure that the play area is free of hazards, debris and trash. On Playground there is a dip in between the wood barrier of the playground and gate that is in need of filling. 369 B. WING 4. Each teacher will ensure that all containers brought from home will be Based on observation labeled with the child's first and last name. The Preschool Director will also check to during inspection the bag or make sure that all water bottles and other container used to containers are labeled clearly. bring a meal from home to the facility for a child was not labeled with the child's first and last name. Ensure that all bags or containers are labeled appropriately.

Based on record review the facility did not provide evidence of health statement for the following children: Child 1 NRS 230 NRS 230 The parents of Child 1 will be obtaining the 04/08/202 Certificate of immunization prerequisite to udated immunizations from the pediatrician 1 admission to child care facility; conditional within one week from today, April 8, 2021. admission; report to Health Division. Except In the future, immunizations held on file as otherwise provided in NRS 432A.235 for need to be current. The person responsible accommodation facilities: for doing this is the child's teach Based on record review the facility did not provide evidence of current immunizations for the following children. Child 1 See Child identifier list located in documents.

The facility is licensed for 42 children as a Center. The census at the time of inspection was 4 children. 4 child's files and 2 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 facility is licensed for 42 children as a Center. The census at the time of inspection was 8 children. 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

This Statement of Deficiencies wasgenerated as a result of the on-site State licensure survey conducted at yourfacility on 9/5/2024. Please respond toeach deficiency and attach documents as requested for the deficiency itpertains to. Sign and submit your Planof Correction within 10 business days of receipt. Inspection consensus, thefacility is licensed for 40 children as a center. 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: JULIE GILMER Title: Director Date: 09/16/2024 REPRESENTATIVE'S SIGNATURE 369 B. WING _______________________ 09/05/2024 CHRIST THE SERVANT LUTHERAN PRESCHOOL 2 S. PECOS RD, HENDERSON, NEVADA ,89074 The census at thetime of surve... Based on observation and record review on 9/5/2024, parent was not informed of right to view complaints made against facility. Ensure parents sign NRS 178 notification form and it is kept in the child's file. Facility failed to have signed copy of form notifying parents of right to request complaint information for the following children as referenced on the identifier sheet: Child # 1-8 NRS 230 NRS 230 1. Both parents were informed and asked to 09/09/202 bring in updated immunization records 4 Division Based on interview and record review, child(ren) as noted below failed to have current immunization records on file at time of inspection. Please submit a copy of the current immunization record for child(ren) noted below: Child #4 and #7: missing 4 yr. old shots (1 round of DTP, Polio, MMR, and Varicella). Each record should show 5 rounds of DTP, 4 rounds of Polio, and 2 rounds of MMR and Varicella).

This Statement of deficiencies was generated as a result of the onsite State licensure inspection conducted on 02/20/2024. There were no regulatory deficiencies observed at the inspection. This facility is licensed for 42 children as a center. The census at the time of inspection was 6 children. 10 child files and 3 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