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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371421
Report Date: 08/04/2023
Date Signed: 08/04/2023 04:38:06 PM

Document Has Been Signed on 08/04/2023 04:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MAGICAL STAR MONTESSORI-PRESCHOOLFACILITY NUMBER:
304371421
ADMINISTRATOR:VITHANAGE, IRA DAYANIFACILITY TYPE:
830
ADDRESS:1636 WEST CATHERINE DRIVETELEPHONE:
(714) 696-1241
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 13DATE:
08/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Ira Dayani Vithanage TIME COMPLETED:
03:00 PM
NARRATIVE
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On 08/04/2023, Licensing Program Analyst (LPA) Romy Castanon conducted a Case Management due to deficiencies observed during today's inspection. LPA Castanon met with Director Ira Dayani Vithanage. Observed at the time of the visit was a total of 13 infants and 4 staff members.

A review of the Facility Personnel Report Summary on 08/04/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions, except for Roshan Rathugamge (start date: 06/03/2023). LPA informed director staff above was not listed as associated to the facility on report summary. Staff Roshan had her fingerprints taken on 05/17/2023. Upon further review of the staff personnel file and Guardian records, Director discovered the live scan request form was incomplete, therefore an eligible fingerprint clearance does not exist for staff Roshan. A civil penalty is being assessed today.

Based on LPA’s interview conducted with Director, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101170(e)(1) Criminal Background Clearance for one (1) staff not cleared to work at the facility.

Appeal Rights were discussed. The facility representative was provided a copy of their 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Ira Dayani Vithanage.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee shall have LIC9224 (Acknowledgement of Receipt) signed and kept in each child's file.

End of Report

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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 08/04/2023 04:38 PM - It Cannot Be Edited


Created By: Romelia M Castanon On 08/04/2023 at 03:29 PM
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: MAGICAL STAR MONTESSORI-PRESCHOOL
FACILITY NUMBER: 304371421

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/11/2023
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidenced by:
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Director will submit fingerprint documentation to Guardian for review on 08/04/2023. Staff Roshan will not be able to return to work at the facility until an eligible clearance is recieved from Guardian. Director will gain access to Guardian, review webinars/user guides to begin utilizing the program. Director will submit copy of Staff Roshan's clearance page to LPA by POC date.
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Based LPA's record review, no criminal clearance for Roshan Rathugamage who has been employed at the facility since 06/03/2023.
This poses an immediate risk to the health and safety of 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:Rina Lopez
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023


LIC809 (FAS) - (06/04)
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