Incident investigation·April 14, 2021

This case management inspection was conducted by Licensing Program Analyst (LPA) Jeanette Estrada on 4/14/21. Due to COVID-19 and precautionary measures, this tele-inspection was conducted via ZOOM Meeting with Site Supervisor, Vilma De Leon. LPA conducted staff interviews regarding a self reported incident that occurred on 4/5/2021 and was reported on 4/7/21. Per the incident report submitted to the RO, on 4/5/21 Child #1 (C1) was running and bumped into Child #2 (C2). C1 fell and scraped the right shoulder and Staff #1 (S1) assisted C1 by cleaning the wounded area. C1 kept playing and appeared fine during the day. Per UIR, C1's parent was notified and provided an incident report on the same day, 4/5/21. During tele-inspection, Staff #2 (S2) demonstrated area where incident occurred LPA observed that there was adequate supervision when incident occurred. On the day of the incident there were 3 children present and 3 Staff present. Per the interview with S2, C1 and C2 were playing together and just happened to bump into each other. S1 was standing the closest to C1 and C2 and was able to assist right away. C2 was not affected by incident. C1 was observed to not be using the right arm during the day on 4/6/21. Per S2, C1's shoulder was noticed to be lower than normal. S2 stated that parent was notified. Per S2, the following day 4/7/21, C1 was not present. S2 contacted parent and parent disclosed that C1 was taken to Urgent Care and their clavicle was broken. This is when facility reported incident to Licensing. Per Site Supervisor, Parent provided a doctor's note and the Facility Health Department created an Individual Health Care Plan based on Doctor's orders to implement for C1 when they returned to school. Per S2 and Site Supervisor, Individual Health Care Plan was discussed with Parent and has been followed since 4/12/21 when C1 returned to school. Based on information obtained on this date, and interviews conducted, no follow-up is necessary regarding the incident. Facility followed the required protocol for reporting requirements as the incident was reported to Child Care Licensing when they became aware of the medical attention that was provided. No deficiencies were cited on this date. Exit interview was conducted with Site Supervisor, Vilma De Leon. This report along with a copy of the appeal rights will be sent to the Site Supervisor via email with a read receipt or confirmation of receipt of email, which will act as the Facility Representative's signature. A copy of the signed report will also be sent to the Department.