Incident investigation·October 22, 2021

LPA Pete Hernandez met with Schadonna Jackson, Director, for an unannounced Case Management - Incident inspection. The purpose of the inspection is to review an unusual incident report, UIR, that was self reported on 10/14/2021. This incident involved C1 and a potential lack of supervision on 10/13/2021. There was one injury resulting from this incident. LPA inspected the physical plant. LPA interviewed staff. LPA also reviewed incident report, staff files, Due insufficient information at this time, this incident is still under review. A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, An exit interview was conducted with the licensee. A copy of this report was discussed and left with the Licensee, Schadonna Jackson , whose signature on this form confirm receipt of these documents. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.