complaint·May 6, 2025

The investigation revealed that on 01/24/2025, C1 sustained a left elbow dislocation. The incident occurred when Staff #3 (S3) who was walking C1 by holding the left wrist of C1. C1 fell to their knees but S3 did not release their grip. KPUC diagnosed C1 with a dislocated left elbow. Video footage of the incident and statements provided by S3 and facility staff supports how C1 sustained the left elbow injury. Additionally, a similar incident involving S3 occurred on 08/19/2024 when C1 sustained a right elbow injury after S3 held onto C1’s right wrist when C1 lost footing. Based on the department’s interviews, medical records review, video footage observations and the previous incident, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The facility is being cited a Type A deficiency in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 101223(a)(2). Definitions are being cited on the attached LIC 9099D page. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parents. An exit interview was conducted and a copy of this report and appeal rights was provided to the Assistant Director. A Notice of Site Visit was also provided, Notice of Site Visit must be posted for 30 days. LPA informed the Assistant Director that enhanced civil penalties may apply. page 2 of 2