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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313549
Report Date: 03/22/2023
Date Signed: 03/22/2023 06:40:52 PM

Document Has Been Signed on 03/22/2023 06:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FERNANDO, RASIKAFACILITY NUMBER:
304313549
ADMINISTRATOR:FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
03/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Licensee, Rasika Fernando TIME COMPLETED:
07:00 PM
NARRATIVE
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Licensing program analyst (LPA) Dianna Valdez Santana conducted a case management visit due to a deficiency observed during complaint investigation visit on 03/22/2023. On 03/22/2023, LPA Valdez Santana arrived at the facility at 12:30pm. LPA met with licensee, Rasika Fernando and toured the facility. During the inspection, LPA Valdez Santana observed 2 staff members and one volunteer providing care for 14 children. Of the 14 children in care, 4 of whom were infants, 6 preschool age children and 4 school age children.

Based on LPA observations, interview and record reviews, daily sign in sheet the facility was operating over capacity. The facility representative was advised of over capacity violation and a correction needs to be made by today. Capacity compliance has to be maintained at all times for the safety of the children in care. LPA provided licensee a copy of the Department’s Capacity Regulations for her reference since this is a repeat violation within the same year. Licensee stated she normally operates at a 12 capacity with four infants allowed but today one of the school age children missed school and was dropped off 10:50am along with their infant sibling, leaving her over capacity. Since she normally operates at a capacity of 12, four of whom are infants, licensee did not realize she was over capacity since she did not exceed 14 children. The facility is licensed to care for 14 children but cannot exceed 3 infants (birth- 24 months). The licensee is operating out of capacity. This poses an immediate risk to the safety of children in care.

Therefore, the preponderance of evidence standard has been met, the of facility operating over capacity is found to be substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, Section 102416.5(d)(1) Staffing Ratio and Capacity is being cited on the attached LIC 9099D. A civil penalty of $250.00 is being issued today as this has been cited twice within the last 12 months.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
VISIT DATE: 03/22/2023
NARRATIVE
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Section 102416.5 (d)(1) Staffing Ratio and Capacity: (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

Licensee was also cited on 04/12/22 for 102416.5(d)(1) Staffing Ratio and Capacity, making this a repeat violation.

The facility received a Type A violation, the facility shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the facility shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.


Exit interview was conducted with licensee, Rasika Fernando. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Licensee was informed of how/where to access regulations and forms from CCLD website: www.cdss.ca.gov. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

Page 2 of 2. End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/22/2023 06:40 PM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 03/22/2023 at 05:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FERNANDO, RASIKA
FACILITY NUMBER: 304313549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/23/2023
Section Cited
CCR
102416.5(d)(1)

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(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home,including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
(1) Twelve children, no more than four of whom may be infants; or
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Licensee stated, they will make sure they communicate with parent of C8 and inform the parent when there are 4 infants in care and child can not be dropped off. LPA Valdez Santana provided a copy of "Capacity Regulations" Sheet. LPA will return to clear citation.
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 (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
This requirement is not met as evidenced by:
Based on observation, and interview, at 12:30pm, LPA Valdez Santana took census of the children present, observed 4 infants & 6 preschool & 4 school age children in the childcare facility.
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Licensee will submit a written statement witn plan of correction within 24 hours to LPA via email at: Dianna.valdezsantana@dss.ca.gov

Licensee will send signed LIC 9224 to LPA via email.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Thuy Ho
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023


LIC809 (FAS) - (06/04)
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