Incident investigation·April 21, 2026

On 4/21/2026 at 9:30am, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced case management- incident visit in response to a self-reported unusual incident report (LIC 624) received on 04/03/2026 regarding an incident during nap time. Upon arrival, LPA met with director, Nellie Joustra. A walk through of the facility was conducted, and a census was taken. Total census was 12 infant children and 4 staff. A review of staff criminal clearance records on this date 04/21/2026 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 04/03/2026, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. On 04/02/2026 Child 1 (C1) was taking a nap in the green room and Staff 1 (S1) went to check on the child and observed C1’s head was wet and there was dried blood on the mouth. Director was contacted to check on the child and paramedics were contacted. At approximately 2pm, paramedics arrived and parents of C1 arrived shortly after. Paramedics checked C1 and vitals and temperature was normal. Parents took C1 to the doctor's for additional check up. During today's visit, LPA interviewed 2 staff, and obtained parent correspondence, safe sleep logs from March-April 2026, 4/2/26 unusual incident report (LIC 624), C1's health history (LIC 702) and C1's emergency identification form (LIC 700). Continued on Page 2 Page 2 During staff interviews, S1 stated at approximately 1:30pm in the green room during a 15 minute sleep check they observed C1 on the cot sweating profusely, excessive drooling, and noticed mild blood stains on C1's sheet coming from the child's mouth. S1 checked C1 for fever and C1 did not have fever. Staff 2 (S2) was called by a infant teachers to check in on C1. After S2's observation, S2 contacted the paramedics and paramedics arrived at approximately 2pm. Paramedics checked C1 and temperature and vitals were normal. Parents of C1 arrived shortly 3-4 minutes after. S1 stated C1 was normal throughout the day. S2 stated parents took C1 to doctor's for additional check up. Based on record review, LPA reviewed green room sleep logs for the week of 3/30/26-4/2/2026 and logs were found to be in compliance. LPA reviewed the 4/2/2026 sleep log for C1 and observed 15 minute sleep checks between 1pm-1:30pm. LPA review parent correspondence on 4/2/26 and at 6:02pm parents informed facility C1's temperature and vitals were normal and the doctor stated C1 was chewing on the right inside of the cheek which explained the blood. Parents stated that the child went to the dentist on 3/31/2026 and did not find new teeth breaking in which may explained the increase in saliva. Based on LPAs interviews and record review, the facility followed safe sleep regulations, the child returned to the facility on 4/6/26, facility is preparing a plan for future incidents, and facility reported the incident in a timely manner. No deficiencies cited during today's visit. An exit interview conducted with director, Nellie Joustra. Notice of Site Visit was provided and must be posted for 30 consecutive days. End of Report