Incident investigation·June 25, 2024

On 6/25/2024 at 11:15AM Licensing Program Analyst (LPA) K.Navar conducted an unannounced Case Management Unusual Incident visit. Upon arrival, the LPA met with Site Supervisor Nury Balmaceda and discussed the unusual incident. The census at the time of the of visit was 15 children supervised by 3 staff during playground time. A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance. The Department received an incident report on 5/16/2024 stating that on 5/15/24 Child #1 (C1) was picked up by an authorized representative and taken to the afternoon school program. When parent guardian arrived at facility to pick up C1 staff realized C1 was not with the group. Parent Guardian then went to after-school program and picked up C1. Teacher witnessed parent guardian pick up C1. On 6/25/2024, the LPA interviewed 1 staff (S1). S1 stated that staff used a walkie talkie to communicate that C1 was leaving the facility and staff did not sign child out. A type B citation will be issued as this poses a health and safety risk to children in care. A person who removes the child from the center during the day and returns the child to the center the same day, shall sign the child in/out. LPA obtained and reviewed the following documents. A copy of sign in and out sheet, roster, copy of procedure for sign in an out, C1’s consent form for after school program. Based on the LPA’s observations, interviews, and records reviews, the following deficiency of Title 22 Division 12 was cited: 101229.1(c) Sign In and Sign Out (SEE LIC809D ATTACHED) Continue to page 2. Page 2 LPA K.Navar informed Site Supervisor Nury Balmaceda that this licensing report dated 6/25/24 documents one “Type B” citation. An exit interview was conducted and The Notice of Site Visit was posted during the visit. The 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. First-level appeals should be sent to the regional manager to the address listed above. End of report.