Incident investigation·May 28, 2026

On 05/28/26 at 8:50am, Licensing Program Analyst (LPA) Diana Ortiz conducted an unannounced Case Management-Incident Report visit. LPA entered through main school office where Program Manager was then contacted. At approximately 9:20am, Program Manager Tiffany Carey arrived. LPA was guided on a tour of the facility. LPA observed 14 children and three (3) staff present during this visit. The department received an unusual incident report on 05/14/2026 via telephone call for an incident that occurred on 05/12/26. Written report was received on 05/14/2026. Per Title 22 Regulations CCR 101212(d)(1)(B) the facility failed to report the incident in a timely manner. During today’s visit, LPA conducted interviews with Program Manager, and one (1) staff. LPA reviewed two (2) staff files, and one (1) children’s file. LPA obtained a doctors note for child #1 (C#1), and the CSPP Health Notification Form. LPA toured the facility. LPA observed the classroom where the incident occurred. Based on staff interviews, both Staff #1 (S#1) and Staff #2 (S#2) reported that during lunchtime, Child #1 got off his chair and began crawling on the classroom floor. According to staff statements, the child looked up, lost his balance, and fell forward, striking his chin on the edge of a chair. Staff immediately observed the child crying and noticed what appeared to be a drop of blood on his shirt. The child was promptly escorted to the nurse’s office where first aid was administered, and the parents were notified immediately thereafter. Parents subsequently picked the child up and informed staff they would seek further medical evaluation at the emergency room. Interviews confirmed there were approximately 10–11 children present with two staff members supervising at the time of the incident, including Staff #2 and an instructional aide. Staff stated supervision was adequate and appropriate ratios were maintained. Per S#1, child remains enrolled at the facility. LPA was provided a copy of the off-school order indicating the child was cleared to return to school on 05/27/26. Page 1 of 2 After interviews, observation of the areas and documentation of the incident, it was determined that staff were unable to prevent the incident from happening; therefore, there is no preponderance of evidence to determine that a regulatory violation occurred, the incident was determined to be an accident. However, Per Title 22 Regulations CCR 101212(d)(1)(B) the facility failed to report the incident in a timely manner. This poses a potential risk to the health, safety and personal rights of children in care. LPA reviewed title 22 regulations with Program Manager about Reporting Requirements and the many ways of submitting an Unusual Incident Report. Program Manager understood. Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. A notice of site visit was provided, and appeal rights were provided and discussed. Exit interview conducted and report reviewed with Program Manager, Tiffany Carey. Page 2 of 2