Incident investigation·May 7, 2025

Licensing Program Analysts (LPAs) Farida Raja and Albert Mendoza arrived to conduct an unannounced Case Management inspection in response to an unusual incident that was self-reported by the facility to Licensing on April 30, 2025. The incident occurred on 04/29/2025 between 3:30-4:00 PM involving child, C1 and supervision. LPAs met with Director, Ruma Chokshi and informed her of the reason for the inspection. LPAs toured the facility and interviewed five staff including Director. LPAs also inspected the physical plant. Facility is located behind Bishop Elementary School in Building H. Director stated that there were between 17 to 13 school age children and three teachers in the elementary school playground at the time of the incident. Based on interviews, after conducting name to face count, children were walking back from the elementary school playground with staff when child, C1 left the group and went back to the playground unnoticed. Staff and children walked past the gate connecting the facility playground to the elementary one and into their classroom. Based on interviews, one child with their therapist was present in the play structure area near C1. Director and staff stated that they have been provided additional training after the incident. All staff are required to maintain a children's roster and individually conduct name to face counts every 15 minutes and log them. Additional checkpoints to conduct name to face counts were added when transitioning from outdoors to the classroom. Director provided LPAs with the meeting agenda of the supervision action plan meeting with staff signatures. No deficiencies were cited as a result of today's inspection. Exit interview conducted and report was reviewed with the Director, Ruma Chokshi. A notice of site visit was given and must remain posted for 30 days.