304313549-6-15-2023-06-CC-THOO-CSXVFX-20230619162440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304313549
Report Date: 06/15/2023
Date Signed: 06/15/2023 02:31:02 PM

Substantiated

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
03/21/2023 and conducted by Evaluator Dianna ValdezSantana

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20230321090154

FACILITY NAME:	FERNANDO, RASIKA		FACILITY NUMBER:	304313549
ADMINISTRATOR:	FERNANDO, RASIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 853-8420
CITY:	ORANGE	STATE: CA	ZIP CODE:	92865
CAPACITY:	14	CENSUS: 10	DATE:	06/15/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Licensee, Rasika Fernando		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Unqualified staff providing care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dianna Valdez Santana conducted a complaint investigation regarding the above complaint allegation. LPA met with Licensee, Rasika Fernando. LPA observed 10 children (4 infants, 4 preschool and 2 school-age children) and 3 staff.
A review of facility Personnel Report Summary on today's date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/21/23 Orange County Child Care Office received the following complaint allegation Unqualified staff providing care. Reporting party (RP) stated, While Licensee was out on vacation from January 08-27, 2023, during the hours of 6:30pm to morning 8.30am Weekdays and 24 hours on weekends the children were cared for solely by an unqualified staff who does not have any qualification or training in childcare.

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20230321090154

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: 06/15/2023

NARRATIVE

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During the course of investigation, LPA reviewed 2 staff files, LPA interviewed 2 staff members. Staff 1 (S1) denied Adult 1 (A1) watched any children in care but rather just lived in the home and occasionally helped with cleaning the facility. S1 stated S1 left the assistant and another substitute, Adult 2 (A2) to help care for the children. S1 was unable to provide LPA with A2’s qualifications but stated A2 took her file after A2’s time substituting at the facility during Licensee’s vacation. During Staff 2 (S2) interview, S2 disclosed, A1 watched at least one child until S2 arrived for their shift at 8:00am-8:30am. Children’s sign in/out sheets for January 2023 show at least 4 children arrived at the facility before 8am on at least 12 days of the 20 days licensee was gone on vacation showing either A1 or A2 provided care without the qualified assistant present. LPA Valdez Santana attempted on 2 separate occasions to contact and interview A1 and A2 but was unable to contact A1 and A2.

LPA Valdez Santana contacted 10 parents for an interview and was able to interview 4 parents. 4 of 4 parents interviewed did not disclose any concerns about the facility staff who provide care for the children.

Based on interviews conducted, evidence gathered, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1 Section 102416.1 Personnel Records is being cited on the attached LIC 9099D. Please refer to attached 9099D for documentation of deficiencies.

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.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20230321090154

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/15/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/15/2023 Section Cited CCR 102416.1(d)	1 2 3 4 5 6 7	102416.1(d) Personnel Records- All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is met as evidence by:	1 2 3 4 5 6 7	Licensee stated she did not have a file for A1 because A1 was not a staff but a former roommate. Licensee stated she previously had A2's files at the faciility but once A2 was done substituting A2 took their file. Licensee understands that she must have a file for all volunteers and staff showing proof of
	8 9 10 11 12 13 14	Based on LPA’s interviews, S2 stated A1 watched at least one child before S2’s shift began. Licensee no longer had a file for Adult #1 (A1) and Adult #2 (A2)- volunteer/substitute.	8 9 10 11 12 13 14	CPR, Fingerprint clearance, immunizations, and current Mandated Reporter Training.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC9099 (FAS) - (06/04)

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