Incident investigation·October 25, 2021

Licensing Program Analyst (LPA) Corral conducted a Case Management Inspection to investigate an Unusual Incident Report (UIR) which was self-reported to our office on 10/20/2021. Prior to entering the Facility LPA Corral reviewed the COVID-19 Questionnaire with Site Supervisor, Mindy Ho. Upon entry to the facility, LPA Corral met with Mindy Ho, where 22 school children were observed in care with 3 staff members providing care and supervision. Due to COVID 19 Guidelines, LPA Corral observed staff members wearing face masks, social distancing and following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on 10/22/2021 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The Self-reported incident received on 10/20/2021 stated a 9-year-old child (C1) left the Facility without informing Facility staff. Based on information that was obtained the Facility was unaware of C1\342\200\231s whereabouts for about 50 minutes. LPA Corral conducted this inspection to request additional information and documentation. The Facility Roster (LIC 9040), C1\342\200\231s File, a Site Supervisor Declaration (LIC 855) and the Unusual Incident Report (LIC 624), along with C1 and C2 sign in/sign out record were requested. An interview with Site Supervisor Mindy Ho was also conducted. C1 and C2 were also interviewed. Further Record Review is required. The Notice of Site Visit was posted. Site Supervisor 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. The Site Supervisor was provided a copy of their Appeal Rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Site Supervisor was informed all appeals must be in writing and received by the Licensing office within 15 business days. End of Report.