Incident investigation·October 16, 2024

Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 10/04/2024. LPA met with Site Director, Matthew Pellett. LPA informed director about the purpose of the visit and conducted a walk through of the facility. At the time of the inspection, there were no children present. At 1:45pm, there was a total of 3 staff members and 12 children. A review of staff criminal clearance records on this date 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 10/04/24 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that Child 1 (C1) and Child 2 (C2) were found in the restroom together. During today's inspection, LPA interviewed two staff members, and review statements from the four staff. Staff #1(S1)\342\200\231s statement stated staff was taking out the trash, walked to one bathroom, while Staff #2 (S2) was trying to grab the other bathroom trash, when S2 noticed the bathroom was locked, and up knocking two voices were heard. When it got unlocked it was discovered by (S2) that two children were in there. Staff #5 (S5) stated the children may have been in the restroom together for less than five minutes. Based on the information gathered from the self-reported unusual incident report, interviews with two staff members, review statements from the four staff and a physical plant inspection. It was determined that the staff didn't observe the two children in the restroom together for about five minutes. California Code of Regulations, Title 22, Section 101229(a)(1) Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D. LPA Nguyen informed the director that this report dated 10/16/2024 documents a Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, and personal rights to the children in care. Continued on Page 2 Page 2 Also, LPA Nguyen informed director to provide a copy of this licensing report dated 10/16/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months form the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or other written statement must be kept in the child's file for verification. An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.