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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313549
Report Date: 09/13/2024
Date Signed: 09/13/2024 10:25:32 AM

Document Has Been Signed on 09/13/2024 10:25 AM - 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/
DIRECTOR:		FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Rasika FernandoTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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On 9/13/24, Licensing Program Analysts (LPAs) Dianna Valdez Santana and Olivia Meza conducted an unannounced case management visit to deliver a Non-Compliance Conference Letter to the licensee. LPAs were met by licensee, Rasika Fernando. During today's inspection, LPAs and licensee toured the facility inside and outside and a census was taken as follows: 3 preschool age children and 1 infant being cared for my licensee and her assistant. A review of staff criminal clearance records on this 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.


During today's inspection LPAs observed clutter throughout the licensee’s dining room, there was spoiled fruit with gnats all over them, scissors on the dining table that could be accessible to children. There were construction screws, trash and other construction materials throughout the dining room space. This is an off-limit area however the children walk through this area to enter and exit the facility, this a potential risk to children in care. .

Based on LPAs' inspection and observations, the following Type B violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 102417(b) Operation of a Family Child Care Home on the attached LIC 809D.

Exit interview was conducted with licensee, Rasika Fernando. The Notice of Site Visit was posted. 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. The Licensee 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. End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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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Document Has Been Signed on 09/13/2024 10:25 AM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 09/13/2024 at 09:52 AM
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: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
102417(b)

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102417(b) Operation of a Family Child Care Home: The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
This requirement was not met as evidenced by:
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Licensee stated she would clean up the area by the POC due date. Licensee will email LPA Valdez Santana at dianna.valdezsantana@dss.ca.gov
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Based on LPAs' observations there was clutter,spoiled fruit with gnats, scissors, construction materials, and trash throughout the dining room, that could be accessible to children. This poses a potential risk to 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.
SUPERVISOR'S NAME:Thuy Ho
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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