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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493007
Report Date: 10/06/2021
Date Signed: 10/06/2021 11:18:58 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2021 and conducted by Evaluator Justin Dorsey
COMPLAINT CONTROL NUMBER: 12-CC-20210805171647
FACILITY NAME:MAGIC CAROUSEL MONTESSORI PRESCHOOLFACILITY NUMBER:
197493007
ADMINISTRATOR:NICOLE MEDINAFACILITY TYPE:
850
ADDRESS:17956 SIERRA HIGHWAYTELEPHONE:
(661) 298-4065
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:44CENSUS: 32DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Thushari Heyyanthuduwage and Director Josephine ShirlyTIME COMPLETED:
11:33 AM
ALLEGATION(S):
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9
Staff operating out of ratio.
INVESTIGATION FINDINGS:
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On 10/06/21 Licensing Program Analysts (LPA) Justin Dorsey conducted a complaint investigation at the facility to deliver complaint investigation findings. LPA met with Owner Thushari Heyyanthuduwage and Director Josephine Shirly who guided LPA on a tour of the facility. Upon arrival LPA observed 32 children in care with 5 staff members throughout 3 classrooms. All staff are fingerprint cleared.

During the course of the investigation LPA Dorsey interviewed children, staff and parent of the program. As part of the investigation LPA Dorsey obtained staff time cards and children sign-in sheets. After observing the time cards and sign-in sheets LPA Dorsey found no information that could prove the facility is operating out of ratio. During the complaint investigation visits on 08/12/21 and 10/06/21, LPA Dorsey obseved the facility to be operating within the required ratios.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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 12-CC-20210805171647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL
FACILITY NUMBER: 197493007
VISIT DATE: 10/06/2021
NARRATIVE
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After observations and interviews with parties related to the allegations it was found that the allegations could not be collaborated. Therefore, the allegations have been found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the facility is not providing a safe and healthful environment, Therefore the above allegations are Unsubstantiated.

An exit interview was conducted, a copy of this report read out, and notice of site visit was given to Owner Thushari Heyyanthuduwage and Director Josephine Shirly
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2