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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313549
Report Date: 06/25/2024
Date Signed: 06/25/2024 02:39:59 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
04/16/2024 and conducted by Evaluator Dianna ValdezSantana
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20240416143559
FACILITY NAME:FERNANDO, RASIKAFACILITY NUMBER:
304313549
ADMINISTRATOR:FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:14CENSUS: DATE:
06/25/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Facility Representative, Tharindu FernandoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Licensee is not home 80% of the time.
INVESTIGATION FINDINGS:
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On 6/25/24 Licensing Program Analyst (LPA) Dianna Valdez Santana made an unannounced visit to Rasika Fernando Family Childcare Home for the purpose to deliver findings of a complaint received. Upon arrival, LPA was met by Licensee’s son, Tharindu Fernando who was explained the reason for today’s visit. LPA was provided a tour of the facility and observed 2 Assistants and 8 children present (3 infants and 5 preschool-age children) at the time of the inspection.
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 4/16/24 the Orange County Child Care Office received the following complaint allegation, Licensee is not home 80% of the time.
Reporting party (RP) stated, Licensee is not home 80% of the time because RP was told the licensee will be back in 2 days from the assistant. RP stated RP never sees the licensee; the licensee is always gone.
Page 1 of 3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
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 6
Control Number 06-CC-20240416143559
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: 06/25/2024
NARRATIVE
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During the course of investigation, LPA reviewed 3 staff files and obtained a Children’s Roster. LPA interviewed 3 staff members, 2 parents and 2 children.

During the staff interviews licensee was only available through phone call for a partial interview due to licensee being out of the country. Licensee stated she was in Sri Lanka and did not know when she was going to return back to the United States. Licensee stated licensee left out of the country due to a family friend’s passing. Licensee stated she was back in her home (in the United States) for a week and returned to Sri Lanka on April 10 (her son showed LPA the flight receipt confirming she left on April 10, 2024). Licensee also stated she is getting some cosmetic treatment in Sri Lanka.

Staff 2 (S2) stated the individuals living in the licensee’s home are, the licensee, staff 2(S2), Staff 3(S3) and Staff 4 (S4). S2 said licensee is currently in Sri Lanka, licensee left in April. According to S2, licensee has been back and forth since October of last year. Licensee was gone from October-April. Licensee came back in April for one week and went back to Sri Lanka. S2 stated licensee does live in S1’s house when S1 is here (in the U.S.) S1 lives here.

Staff 3 (S3) stated S3 moved into the facility in February 2024 and started working at the facility in March. S3 said the individuals living in the home are S1, S2, S3 and S4. S3 disclosed that S1 comes and goes. S3 is living temporarily at the facility since S3 will be returning to S3’s home country. S3 stated S1 is in Sri Lanka and was here (U.S.) when S3 arrived in February. S3 stated S4 hired S3. S3 said S1 came for a couple of days 5 or so in February or March and in April S1 came for a week and went back to Sri Lanka. S3 said S1 lives in this house and S1 comes and goes. Staff 4 (S4) started working at facility since around November/December of last year. S4 said S4, S1, S3 and S2 live in the home. S4 is S1’s son and S4 stated S4 moved to the facility in December of 2023. S4 stated S1 is in Sri Lanka, S1 left April 10, 2024. S4 stated S1 was in the U.S. in October, November, and traveled in the middle of the month in December. In January, S1 came for bit and then returned. In February and March S1 was in Sri Lanka and in April S1 was here (U.S.) for a week and then had to return. S4 stated S1 does live in the home and that S1 comes and goes.

LPA Valdez Santana contacted 4 parents for an interview and was able to interview 2 parents. 2 of 2 parents. interviewed did not disclose any concerns about the facility staff who provide care for the children. Child #1 (C1) stated S1 “is not here a lot.”

Page 2 of 3

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

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20240416143559
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: 06/25/2024
NARRATIVE
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The preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1 102417(a) Operation of a Family Child Care Home, Type B is being cited on the attached LIC 9099D. Please refer to attached 9099D for documentation of deficiencies.

Exit interview was conducted with Tharindu Fernando, because licensee is currently out of the country. 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 3 of 3. End of Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 06-CC-20240416143559
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: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2024
Section Cited
CCR
102417(a)
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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. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise
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Facility representative, Tharindu Fernando stated the licensee is currently unwell and cannot travel back until her Doctor says she is able to travel. Facility representative stated he has been overseeing the licensee's duties in her absence, ensuring the safety of children, communicating with parents & staff.
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 the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met as evidenced by: Based on LPA’s interviews, staff #1, Staff #2, and Staff #3 disclosed that S1 has been out of the country off and on since October of 2023 until present. Licensee is out of the facility more that than 20% of the time.
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He will email LPA Valdez Santana the licensee's Doctor's note.
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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: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
04/16/2024 and conducted by Evaluator Dianna ValdezSantana
COMPLAINT CONTROL NUMBER: 06-CC-20240416143559

FACILITY NAME:FERNANDO, RASIKAFACILITY NUMBER:
304313549
ADMINISTRATOR:FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:2619 N FERNSIDE STTELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:14CENSUS: DATE:
06/25/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Facility Representative, Tharindu FernandoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Unqualified staff providing care.
INVESTIGATION FINDINGS:
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On 6/25/24 Licensing Program Analyst (LPA) Dianna Valdez Santana made an unannounced visit to Rasika Fernando Family Childcare Home for the purpose to deliver findings of a complaint received. Upon arrival, LPA was met by Licensee’s son, Tharindu Fernando, who was explained the reason for today’s visit. LPA was provided a tour of the facility and observed 2 Assistants and 8 children (3 infants, 5 preschool-age children) present at the time of the inspection.
A review of the Facility Personnel Report Summary conducted on today’s date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 4/16/2024 a complaint was filed with the Licensing office stating, Unqualified staff are providing care. The Reporting Party (RP) stated, RP never sees the licensee, the licensee is always gone and there is always a lot of adults in the home and RP does not know if they are qualified or not and have the required training. Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20240416143559
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: 06/25/2024
NARRATIVE
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During the course of investigation, LPA interviewed 4 staff members, 2 parents and 2 children.

During the staff interviews, Staff 2 (S2), disclosed there are no other adults are present during daycare hours. Staff 3 (S3) said there are no other adults here during daycare hours, other than S1, S4 and S2. S3 denied there have adults with no fingerprint clearance or any other adults like monks. S3 stated S3, S2 and S4 take care of the children and S1 when S1 comes. Staff 4 (S4) denied that there has ever been other adults here during daycare time, it’s just staff. S4 stated S2 and S3 takes care of the children.

LPA reviewed S2, S3, and S4 files and all 3 staff have all required training certificates in their files.

2 of 4 parents were interviewed, 2 of 4 parents interviewed had no issues or concerns with the daycare. 2 out of 2 children did not make disclosures.

Based on LPA’s interviews and record reviewed, there was not enough evidence to corroborate the allegation of Unqualified staff are providing care. 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, and report was reviewed and discussed. Notice of Site Visit was posted during the visit. 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 per day. The facility was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

Page 2 of 2. End of Report.

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

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6