Kushi Daycare and Montessori

This Statement ofDeficiencies was generated as a result of the on-site State licensure inspection conducted at your facility on2/10/2026. Please respond to each deficiencyand attach documents as requested for the deficiency it pertains to. Sign and submit your Plan of Correctionwithin 10 business days of receipt. Inspection consensus, the facility islicensed for 12 children as a group care. The census at the time ofsurvey was 8 children.0 If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECT 432A.200.4: Staff not added to NABS w/in24 hrs.; Fingerprinting not completed w/in 24 hr. of hire Based on record review the facilityfailed to ensure that all staff were added to the facility’s NABS Roster attime of inspection. All staff new/transfers need to be added to facility NABSRoster within 24 hours of hire/transfer. Please add the staff below Alayasia B. Complete 4 POC questions

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 06/13/2025. The facility is licensed for 12 children as a Group Care. The census at the time of survey was 8 children. 8 children's files and 6 staff files were reviewed. Reminders: Ensure sign in/out times are properly 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: KUSHARI DUKE DE Title: Owner Date: 07/17/2025 REPRESENTATIVE'S SIG 3. The changes that were made is before a fire drill a teacher must prepare the firedrill Based on observation and interview, log before hand to ensure that it is taking the facility had no record that a fire drill lace and being logged properly was held at least once each month. 4. Kushari Peiris The last fire drill logged was 04/25/2025. Please upload the fire drill log to verify that a fire drill has been conducted since that date. Answer 4 POC questions. NAC 306 1. Every caregiver in a child care facility NAC 306 Indrani Rajendra has not been a part of the 06/13/202 must: daycare in some Based on interview and record review, 3483 B. WING _______________________ 06/13/2025 KUSHI DAYCARE AND MONTESSORI 3275 S TIOGA WAY, LAS VEGAS, NEVADA ,89117 the facility failed to ensure that within 120days of hire each employee had a Nevada Registry certificate present for Indranis R. Please upload a current Nevada Registry Certificate/proof of membership for Indranis R. Answer 4 POC questions. NAC 323 1. Except as otherwise provided in NAC NAC 323 The specific action taken to fix the 06/17/202 432A.521 and NRS 432A.177, within 120 defficiency was Make sure Kushari peiris 5 days after commencing his or her got up to date on her certifications and employment or position in a child care regarding Indrani she was put on hold but facility, each person who is employed in a we havent used her ... Based on interview and record review, the facility failed to ensure that within 120days of hire each employee completed the required hours of training in childcare. Please upload proof of trainings for: Kushari D. Missing 2 hours of Human Growth & Development or Positive Guidance and 2 hours of Wellness. Indranis R. All initial trainings. Answer 4 POC questions. NRS 230 NRS 230 The specific action that was taken place 07/24/202 Certificate of immunization prerequisite to was we had the parents bring in the 5 admission to child care facility; conditional updated forms as the kids were already 3483 B. WING _______________________ 06/13/2025 KUSHI DAYCARE AND MONTESSORI 3275 S TIOGA WAY, LAS VEGAS, NEVADA ,89117 ID (EACH DEFIC Based on observation, review of records, the facility did not assess each child within three months after enrollment in the facility or repeat assessment every six months. Please upload assessments for Child #1 on the identifier list. Answer 4 POC questions. 3483 B. WING _____ Based on observations, the facility failed to ensure that the changing table mat and the area beneath it were properly cleaned. The area was not well maintained and requires immediate attention to meet cleanliness standards. Upload pictures of corrections. Answer 4 POC questions.

The facility is licensed for 12 children as a Group Care. The census at the time of investigation was 11 children. 0 children's files and 0 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: KUSHARI DUKE DE Title: Owner Date: 05/26/2025 REPRESENTATIVE'S SIGNATURE LANEROLLE Based on observation, toilet paper was not in the dispenser for children to easily access themselves when using the bathroom. NAC 412 1. Each facility must have written NAC 412 1. The specific action that was taken was a 05/22/202 procedures concerning the washing of paper towel holder was installed right next 5 hands. to the sink for handwashing and drying. 2. The staff of a facility shall follow the 2. 05/22/2025 procedures of the facility concerning the 3. The changes are that each teacher will washing of hands and shall instruct, monitor ensure it is fully stocked for the day and that and Based on observation, one towel on top of bathroom sink used for all children to dry hands but need to have single-use disposable paper towels in dispenser for each child to easily access themselves.

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 1/24/2025. The facility is licensed for 12 children as a Center. The census at the time of survey was 11 children. 0 children's files and 0 staff files were reviewed. Reminders: Continue to remain staff and child files because all files will be reviewed during annual inspection. 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: KUSHAR Based on observation and interview, the facility failed to update the NABS roster to include new staff within 24 hours of employment. Please ensure the NABS roster is updated to include Alayasia B. Upload the updated NABS roster to confirm that Alayasia B. has been added. Answer the 4 POC questions as required. NAC 250 1. Except as otherwise provided in this NAC 250 1. The specific actions taken place to 01/24/202 subsection, subsection 3 and NRS correct the deficiency were done while the 5 432A.078 in each facility there must be: inspection was being done the actions for (a) At least 35 square feet of indoor space the tree stub was that it was covered in a for each child, exclusive of bathrooms, protective sheet and wrapped many times halls, kitchen, stairs, storage spaces, ensuring that ... Based on observation and interview, the facility was found to have hazards as listed below: -A large tree stump on the right-hand side of the playground, next to the wall, was observed to have rigid, rough edges at the ends of the stump, which pose a potential safety hazard. Ensure the ends of the tree stump are securely covered or resurfaced to eliminate all rigid and rough edges. Upload picture of corrections. -Wood board in the dirt area under the tree needs to be removed-Corrected on site. Answer 4 POC FORM APPR each employee when a parent comes to pick up or drop off a reminder will be given Based on interview and record review, the each time and a proper check is done to facility failed to maintain a daily sign-in make sure each child was properly signed sheet that included the times of arrival and in and out. departure for staff and/or children. To 4. The person responsible was Kushi Peiris ensure times are consistently recorded, and Harith Peiris as they both should have please provide instructions to parents and been monitoring properly. monitor the daily sign-in sheets. It is recommended that o Based on observation, the following hazards identified: -Nap room: 1 missing outlet cover was observed on the right hand wall-Corrected on site. -Classroom: 3 missing outlet covers were observed throughout-Corrected on site. -Mat at the back door was observed to have holes and is a potential tripping hazard- Owner removed it during visit. Corrected on site. Answer 4 POC questions as required. Based on record review and interview, the facility failed to provide and maintain an incident/accident report. Ensure incident/accident reports are accessible and properly maintained moving forward. Answer 4 POC questions.

This Statement of Deficiencies was generated as a result of the on-site State licensure inspection conducted at your facility on 6/5/24. The facility is licensed for #12 Children as a group care. The census at the time of survey was #8 children and # 8children files were reviewed and #2 staff files were reviewed. **PLEASE CONTINUE TO UPLOAD ITEMS TO RENEWAL CHECKLIST. NAC 306 1. Every caregiver in a child care facility NAC 306 1. 06/13/202 must: The specific actions taken to correct this 4 If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt Based on record review the facility failed to provide evidence of NV Registry for the following staff: Harith P. Answer 4 poc questions and upload NV registry NAC 323 1. Except as otherwise provided in NAC NAC 323 1. 06/13/202 432A.521 and NRS 432A.177, within 120 The specific actions taken place to fix the 4 days after commencing his or her problem with Hariths certifications were to employment or position in a child care redo the CPR and do the Shaken baby facility, each person who is employed in a syndrome and abusive head trauma along child care facility, other than a person with the administer of medication course employed in a facility that provides care for which was completed on June 28 of 2024. ill children, and each director of a child care The only certification we are waiting o... Based on record review the facility failed to provide evidence of initial trainings for the following staff: Haritha P. - Shaken Baby and abusive head trauma and Administration of medication Answer 4 poc questions and upload documentation. NRS 178 Child care facility required to maintain NRS 178 1. 06/13/202 certain information; reporting of information The specific actions taken to correct the 4 to parents and guardians; notice of right to mistake was the next time the parent came information. to the facility we had her sign the form and 1. A child care facility shall maintain a copy explain Based on record review one child file did not have the NRS 178 signed by parent. Child 8 Answer 4 poc questions and upload signed NRS178 NRS 230 NRS 230 1. 06/13/202 Certificate of immunization prerequisite to The specific actions taken place to correct 4 admission to child care facility; conditional the mistake was that we informed Child # 8 admission; report to Health Division. Except mom to bring in the updated shot record as otherwise provided in NRS 432A.235 for then next time she and Child #8 came to the accommodation facilities: daycare. 1. Except as otherwise provided in subsection 3 Based on record review one child did not have an updated 3483 B. WING _______________________ 06/05/2024 KUSHI DAYCARE AND MONTESSORI 3275 S TIOGA WAY, LAS VEGAS, NEVADA ,89117

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 01/24/2024. The facility is licensed for 12 children as a group care. The census at the time of survey was 5 children. 6 children's files and 1 staff files were reviewed. Reminder: Please add al resident 18 year of age and older to your NABs roster and ensure to submit payment. 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: KUSHARI Lanerolle who will also be conducting the drills. All drills (fire and disaster) have been Based on observation and interview, scheduled in their respective months and the facility had no record that a drill for will be completed on due dates with natural disasters was held at least once documentation of being done. every three months and no record that a fire drill held at least once each month. Please upload updated fire and disaster drills. STATEMENT OF DEFIC Based on record review and interview, the facility did not have a health statement signed by a registered nurse or physician within 30 days after admission. Please upload proof of health statement for children listed on the identifier list. Child # 2 Child # 3 Child # 5 NRS 230 NRS 230 All children’s immunization forms have been 02/03/202 Certificate of immunization prerequisite to collected and put in a safe folder by Kushari 4 admission to child care facility; conditional Duke De Lanerolle. By 02/02/2024 all admission; report to Health Division. Except children’s immunization forms are coll Based on record review and interview, the facility admitted children who were not up to date with immunizations or for whom no record was present or needed an updated. Please upload updated immunizations for children listed on the identifier list. Child # 1 Child # 3 Child # 4 NAC 430 1. Each facility, including, without limitation, NAC 430 As of 02/02/2024 all assessments for 02/03/202 a family home and a group home, shall children have been conducted which will 4 have an early care and education program. identify the children’s interests, target their 2. Each facility described in subsectio Based on observation, interview and review of records, the facility did not assess each child within three months after enrollment in the facility or repeat assessment every six months. Please upload assessments for children listed on the identifier list. Child # 1 Child # 2 Child # 3 Child # 4 Child # 5 Child # 6

This Statement of Deficiencies was generated as a result of the on-site initial State licensure survey conducted at your facility on 03/27/2023. Facility is approved for 12 children State Fire Marshall and SNHD approved facility for operation. 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