Incident investigation·March 6, 2026

Licensing Program Analyst (LPA) A. Nunez conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 1/16/2026. During today\342\200\231s visit, LPA met with the Director, Chamila Gardiwasam. LPA took census and observed 40 children and 4 staff members. 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. On 1/16/2026, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 1/16/2025 at approximately 10:30am, C1 fell from the climbing play structure and around 12:30pm C1\342\200\231s parent picked up C1 and took C1 to the hospital. It was later determined that C1 had minimal posterior displacement on the right elbow. During the investigation, LPA interviewed the director, Staff#1, Staff#2 and LPA attempted to interview C1, but C1 did not want to be interviewed by the LPA. During staff interviews, Staff#1 (S1) stated the following S1 was standing by the infant classroom and Staff#2 (S2) was standing by the swings. S1 had scanned the playground and C1 was climbing on the climbing structure and when S1 turned back, S1 had seen C1 on the floor crying. S1 believes C1 must have fallen but did not see C1 fall. C1 was holding C1\342\200\231s right arm and S2 took C1 inside the classroom. S1 stood outside with the rest of the children. S2 stated the following: S2 did not see C1 fall. S2 was by the swings of the play structure. C1 was crying during nap time and gave C1 an ice pack and called the parents to pick up C1. The director stated it was later determined that C1 had a minimal posterior displacement on the right elbow. Page 1 of 2 Based on the staff interviews, the facility was not in compliance with California Code of Regulations, Title 22, Division 12 & Chapter 1, 101229(a)(1) Responsibility for Providing Care and Supervision is being cited; see LIC 809-D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Chamila Gardiwasam. Appeal Rights discussed. Director 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. End of Report Page 2 of 2