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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197492889
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:12:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/29/2022 and conducted by Evaluator Shandra Powell
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20220829085541
FACILITY NAME:KANNANGARA FAMILY CHILD CAREFACILITY NUMBER:
197492889
ADMINISTRATOR:KANNANGARA,ATHUDARACHCHIGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 217-9877
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:14CENSUS: 2DATE:
08/31/2022
UNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Athudarachchige Dona Nathasha Kannangara, LicenseeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Personal Rights: Licensee is prohibiting child's authorized person from obtaining records regarding child's care.
INVESTIGATION FINDINGS:
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On 8/31/2022 at approximately 10:30 AM Licensing Program Analyst (LPA) Shandra Powell conducted an initial 10-day visit for the above allegation During inspection LPA observed 2 children in attendance with 2 Adults (Licensee and Mother).

Based upon the evidence obtained during the course of this investigation including interviews, file review and documentation received the above allegation has been UNSUBSTANTIATED: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is Unsubstantiated.

The notice of site visit was posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 58-CC-20220829085541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KANNANGARA FAMILY CHILD CARE
FACILITY NUMBER: 197492889
VISIT DATE: 08/31/2022
NARRATIVE
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Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview was conducted with Athudarachchige Dona Nathasha Kannangara, Licensee. Appeal Rights procedures explained. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2