Incident investigation·September 23, 2025

Licensing Program Analyst (LPA) Erwina Pascual-Golamco, met with Director, (D) Amanda Samson, for a case management visit regarding an incident on 09/09/25. Purpose of the visit was explained. Director self reported and submitted a written Unusual Incident Report LIC624, that on 09/09/25, an infant was fed the wrong bottle, and staff failed to complete their Name-To-Face check before feeding. D stated parents of infants involved were notified, and Director investigated, interviewed staff and witnesses and took necessary actions. Based on interview and record review with Director, Type A Title 22 Deficiency has been issued on the attached LIC 809-D page. LPA informed Director, (D) Amanda Samson, that this report dated 09/23/25 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. LPA informed D to provide a copy of this licensing report dated 09/23/25 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. A Notice Of Site visit was given to D, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. D has been provided with appeal rights. Exit interview was conducted, report was reviewed with Director, Amanda Samson.