Complaint·May 3, 2023

Page 2 During the course of the investigation, LPA interviewed Director, interviewed staff, reviewed child (C1) file, and obtained the facility roster. During staff interviews on 4/28/2023, LPA interviewed staff that had direct knowledge of the incident involving (C1). During staff interviews and reviewing a self-reported incident report dated 4/24/2023, it was determined (C1) was playing in the indoor play yard when (C1) tripped, fell, and hitting their head on the concrete floor. All staff interviewed stated (C1) was lying on the ground, unresponsive. One staff interviewed recalled asking another staff to call for help or the front office. The front office was notified, and a staff member came to the inside play area where the incident occurred. The staff member was returning to the office to call (C1) parents and observed the parent of (C1) inside the facility which the parent was then notified of the incident. Child (C1) was escorted out of the facility by the parent. Parent and (C1) returned inside the facility minutes later and requested the facility to call 911. Facility called 911 per parent request. Based on documents received, LPA interviews with Director and staff, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter 12, is being cited on the attached LIC 9099 D for the deficiency section 101226 Health-Related Services. LPA Thompson informed Director Stefanie Evangelista that this report dated 5/3/2023 document(s) one 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 Thompson informed Director Stefanie Evangelista to provide a copy of this licensing report dated 5/3/2023 that documents any Type A citation(s) 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. Continue to Page 3 Page 3 Exit interview conducted and report was reviewed with the Director Stefanie Evangelista. 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 and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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.