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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313549
Report Date: 04/11/2023
Date Signed: 04/11/2023 10:45:53 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/15/2023 and conducted by Evaluator Dianna ValdezSantana
COMPLAINT CONTROL NUMBER: 06-CC-20230215141330
FACILITY NAME:FERNANDO, RASIKAFACILITY NUMBER:
304313549
ADMINISTRATOR:FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:14CENSUS: DATE:
04/11/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Rasika Fernando TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee is serving expired food
INVESTIGATION FINDINGS:
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On 04/11/2023 Licensing Program Analyst (LPA) Dianna Valdez Santana made an unannounced visit to Fernando, Rasika for the purpose to deliver findings of a complaint received. Upon arrival, LPA was met by licensee, Rasika Fernando. Licensee was explained the reason for today’s visit. LPA was provided a tour of the facility and observed 8 children in care, 4 infants, 2 preschool, and 2 school age children and 2 staff including the licensee.

A review of the Facility Personnel Report Summary conducted on 04/11/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Page 1 of 2



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
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 06-CC-20230215141330
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/11/2023
NARRATIVE
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On 02/15/2023 a complaint was filed with the Licensing office stating Licensee is serving expired food. Reporting party stated, the operator of the child care home is serving the children expired canned food.
During the course of investigation, LPA Valdez Santana interviewed licensee who disclosed that they do not serve expired food and stated that they always check the expiration dates. S2 disclosed that they cook the food and they never use old food. LPA inspected the facility’s pantry, cupboards and refrigerator and did not discover any expired food on the premises. LPA contacted four parents for interviews and was able to interview 1 parent, no disclosure was made.

Based on LPA’s interviews and records review, there is insufficient information to corroborate the allegation of Licensee is serving expired food. 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, the allegation is unsubstantiated.

Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

Page 2 of 2. End of Report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2