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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313549
Report Date: 10/10/2023
Date Signed: 10/10/2023 03:45:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 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
08/25/2023 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230825165149
FACILITY NAME:FERNANDO, RASIKAFACILITY NUMBER:
304313549
ADMINISTRATOR:FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:14CENSUS: 7DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Rasika Fernando, LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not prevent a child from causing multiple bite injuries to another child in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nguyen Nick Tran conducted an unannounced complaint inspection to deliver the findings for the above allegation. This is a continuation of the investigation initiated on 08/29/23. At 3pm, LPA Tran met with Licensee, Rasika Fernando, who guided LPA on tour of the family child care home. Census was taken and observed were 7 children inclduing 3 infants and 2 adults.

A review of the Facility Personnel Report Summary on 10/10/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 08/25/2023, the Regional Office received a complaint with allegation alleging Staff did not prevent a child from causing multiple bite injuries to another child in care.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
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 4
Control Number 06-CC-20230825165149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
VISIT DATE: 10/10/2023
NARRATIVE
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(Page 2 of Report)

During the investigation, LPA interviewed 2 adult members who provide care for the children at the facility and reviewed photo pictures of Child #1 (C1)'s injury.

Both interviewed adults admitted that no one was paying attention to C1 and 2 other children who were playing in the playhouse on the backyard on 08/22/2023. Adult #1 (A1) stated A1 was providing care for a group of children on the other side of the backyard away from the playhouse, while Adult #2 (A2) was taking care of another child away from the playhouse. According to A1, C1 was bitten by C2 multiple times on arm and on face and since C1 did not cry, the adults who were providing care did not know. A1 stated that when A1 checked on C1, in the playhouse A1 noticed bite marks on C1’s arm and face. A1 took C1 inside the house to provide care including washing C1's arm and applying ice. Adult #3 (A3) was not present at the facility when the incident happened and confirmed the information provided by A1 and A2, in which A3 stated A3 questioned both A1 and A2 of the incident, and both A1 and A2 said they did not witness C1 got bitten by another child. According to A3, A2 has recently stopped working at the day care. LPA could not reach A2 for an interview via phone number provided by A3.

During record review, LPA observed photo pictures of C1 with multiple bite marks including 2 bite marks on the right upper arms; 2 bite marks on the hand near the index finger; 1 bite mark on left thumb, 2 bite marks on forehead right between the eyebrows, 2 bite marks on right under each eye, one bite mark above the left side of the nose, 1 bite mark on left cheek, and 2 bite marks on the bottom of the left cheek, 2 scratch marks on left neck.

Based on the information gathered from the interviews on 09/13/23 and record reviews of photo pictures of C1's injury, the following deficiency is observed in accordance with California Code of Regulations, Title 22, Division 12, Section 102417 Operation of a Family Child Care Home. The deficiency is being cited on the attached 809D.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20230825165149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
VISIT DATE: 10/10/2023
NARRATIVE
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(Page 3 of Report)

Due to the Type A violation cited today, the Licensee 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. 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.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Rasika Fernando.

(End of Report)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20230825165149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FERNANDO, RASIKA
FACILITY NUMBER: 304313549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2023
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

This requirement is not met evidenced by:
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Licensee states she will submit a statement of understanding of the regulation regarding Operation of a Family Child Care and a detailed plan of action to ensure supervision for the children in care is provided at all times, to LPA by due date.
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Both interviewed adults, A1 and A3 admitted that no adult was paying attention to C1 and 2 other children who were playing in the playhouse on the backyard on 08/22/2023, which posed an immediate risk to the health, safety and personal rights of the children in care.
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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.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
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