Inspector’s narrative
What the inspector wrote
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Reporting Party (RP) states, \342\200\234I am worried about the whole infant and toddler section\342\200\246 hand foot mouth has been going around for over a month now, when staff reports that a child has developing symptoms the issues are just bypassed. Management\342\200\246 knowingly allowed a child to come into the facility to continue to spread the hand foot mouth disease.\342\200\235
During the investigation, LPA Garcia interviewed 6 staff, 5 parents, reviewed relevant documentation, physician\342\200\231s notes, facility roster, LIC 624, Health bulletin, facility procedures, parent handbook, personnel report, and further relevant documentation.
During staff interviews on 7/3/24, Staff 1 (S1) stated, \342\200\234I haven\342\200\231t not received any information about the illness going on.\342\200\235 S1 stated, \342\200\234When we try to bring in the attention to the child that this child does not feel well. Some people disregard it, and it is up to the me and my co-teacher to contact the parents so the parents pick their child up...\342\200\235 S1 stated, \342\200\234If management would take more seriously with the illness going around because if they do not take care of it. It would be up to my co teacher and I about the illness. If only they can communicate with us if they are absent or present. They expect us to have certain numbers a day and what they expect, and they do not inform us that the child will be absent. It is my co teachers\342\200\231 responsibility to know if they are present or not....\342\200\235
Staff 2 (S2) stated, \342\200\234It is a very irritating subject. I have read the handbook because I am a parent here. If it is diarrhea, it is 24 hours. I am not sure of the policy for HFM. We have several and they allow them to come in...\342\200\235 S2 stated, \342\200\234I have been here since... and they did not train me because the other teacher stopped coming. What I was told to do if they have diarrhea... I will inform admin and they inform parents. There would be times that the administration would forget to call.\342\200\235 S2 stated, \342\200\234S6\342\200\231s response was everybody has it, so it doesn\342\200\231t matter. I am concerned on how management deals with everything.\342\200\235
Staff 3 (S3) stated, \342\200\234.... It was excessive and we got many confirmed cases. We have brought it up. I have asked [management] and why we are not doing a bulletin to let them know there is any outbreak. They didn\342\200\231t tell us. No documentation they have been letting us know through the Sprout about app.\342\200\235
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Staff 4 (S4) stated, \342\200\234If the parents pick up the child, we let them know. We do an incident report as an illness, and we let parents sign that and sign one for the office.\342\200\235 \342\200\235We sanitize the room every night. We clean our toys with bleach water solution. We wash them in water and let them sit over night in bleach water solution. We switch out the toys. Sometimes they [infants] are quicker, and they get to it because of the illness going on. We sanitize all the surfaces. We sanitize the sleeping spaces, there cribs and cots.\342\200\235 S4 stated, \342\200\234There\342\200\231s 4 or 5 confirmed cases and the parents were informed that there were particular cases. There was an email when it first started... but it did not hit our rooms until last week. We told parents as an FYI that we got conformation [of the illness]\342\200\235
Staff 5 (S5) stated, \342\200\234We don\342\200\231t isolate them. They tell us to call and tell us not to isolate children in general and never leave them unattended. There is no way to isolate them in here.\342\200\235 S5 stated, \342\200\234Now that we have observed it the staff tells the parents just in case they did not call. Because I feel like we communicate it up front it does not get delivered in the time frame that it should, and it gets put off and that is why it is spreading. They have been letting children roam around without informing parents because they don\342\200\231t want them to go home.\342\200\235 Staff 6 (S6) stated, \342\200\234They are supposed to send out a bulletin for all the parents and they have not done that recently. That is what they are supposed to do if it gets really bad.\342\200\235 S6 stated, \342\200\234Honestly when we let them know I do not know if it is documented. We write and observation from of anything then happened rash and...we keep it on file. They document illness that\342\200\231s spread but I am not sure if they do that. Our protocol is to message parents if they need to of any documentation done. I am not sure of the protocols that they take.\342\200\235 Staff 6 (S6) stated, \342\200\234Management checks the child, calls the parents, writes and observation log, we write it is an symptom of, we write they need to be cleared by a physician or symptom free for 24 hours. Our rule is that they [parents] need to be 1 hour.\342\200\235 When asked about the isolation area, S6 stated, \342\200\234Right here in my lap. If they are getting picked up and I do not take them out of the room. I bring them up here and bring them on their lap.\342\200\235 5 out of 6 staff stated there is no isolation area for children with illness.
During the course of investigation, LPA received evidence confirming 9 cases of Hands, Foot, and Mouth (HFM) between the dates, 6/14/24-06/17/24. LPA received unusual incident report (LIC 624) regarding the epidemic on 7/3/24. On 7/12/24, LPA received report of an infant vomiting on 7/11/24 at approximately 3:00pm. Based on review of sign in and sign out sheets, the infant returned to the facility on 7/12/24 at 9:26am.
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LPA Garcia contacted 5 parents. 3 out of 5 parents made no disclosures about the allegations.
Based on LPA\342\200\231s staff interviews and record review, it has been determined Licensee does not take adequate measures to prevent outbreaks in the facility, Licensee allows children will illness to return to the facility, Licensee does isolate children with illness, and facility did not report this incident to the Department in a timely manner. The preponderance of evidence standard has been met; therefore, the above allegation(s) are found to be Substantiated. California Code of Regulations, Title 22, Section 101226.1 (a)(1) Daily Inspection for Illness, 101218.1 (2)(B) Admission Procedures and Parental and Authorized Representative's Rights, 101426.2 (b) Infant Care Isolation for Illness, and 101212(d)(1)(C) Reporting Requirements are being cited on the attached LIC9099D. LPA discussed and provided education manager the Title 22 regulations Sections 101426.2 Infant Care Isolation for Illness, 101226.1 Daily Inspection for Illness, 101226 Health related services, 101226.3 Observation of the child, 101221 Child\342\200\231s records, and 101212 Reporting Requirements.
LPA Sarah Garcia informed education manager, Briana Solario, that this report dated 08/01/2024 documents (2) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Sarah Garcia informed education manager, Briana Solario, to provide a copy of this licensing report dated 08/01/2024 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 from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted and report was reviewed with the education manager, Briana Solario. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Appeal Rights were explained. Education manager, Briana Solario was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
End of Report
