Incident investigation·May 8, 2024

Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 04/15/2024. LPA met with Director Gabriel Hall. Census was taken in individual classrooms. The overall census observed was 39 preschool children and 10 staff members. A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 04/19/2024 a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a child fell from the Monkey Bars onto the wood chips. Parents notified the facility on 04/19/2024 that the child was brought to the hospital for x-rays and determined child's arm had a fracture. All three staff interviewed stated they didn't observed the incident. Staff #1 (S1) stated the other staff were spread out between the playground, the sandbox and the bathroom with the children. S1 was scanning the playground and when S1 looked at the grass area S1 noticed child #1 (C1) was sitting on the grass quietly crying. S1 called C1 over because S1 couldn't walk away from the gate. S1 asked C1 why child was crying and stated C1's arm hurts. S1 asked C1 for more details and C1 told S1 that C1 was on the monkey bars and C1's hands slipped and C1 fell onto the wood chips. S1 attended to C1 and notified the parents of the incident. Based on the information gathered from the self reported unusual incident report, interviews with three staff members, a child, statements from the one staff and a physical plant inspection. It was determined that the staff didn't observed the incident. California Code of Regulations, Title 22, Section 101229(a) Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D. Exit interview was conducted with Director Gabriel Hall. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Continued on Page 809C. Page LIC 809C Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.