197700033-5-18-2021-12-CC-CBEL-C7C63P-20210929202726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197700033
Report Date: 05/18/2021
Date Signed: 05/18/2021 02:08:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2021 and conducted by Evaluator Brigitte Tsutaoka

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20210517125621

FACILITY NAME:	SILVA FAMILY CHILD CARE		FACILITY NUMBER:	197700033
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 10	DATE:	05/18/2021
		UNANNOUNCED	TIME BEGAN:	11:38 AM
MET WITH:	Licensee Kumuduni Silva		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Allegation 3: Uncleared adults are working in the childcare

INVESTIGATION FINDINGS:

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On May 18, 2021, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an initial inspection on the above allegation. LPA disclosed the purpose of the inspection and was granted entry by Licensee, Kumuduni Silva, who guided LPA on a tour of the facility. Upon entry, LPA counted 10 children in care. COVID-19 Emergency Waiver is posted in the facility.

During inspection LPA conducted interviews with Children and Licensee. Based on interviews conducted, it was determined the Licensee's two adults daughters are living at the facility. Interviews conducted also disclosed Staff 1 has been present at the facility for 4 days while children have been in care. Licensee's daughters and Staff 1 are not on association sheet. LPA observed Licensee's two adult daughters at the facility. During inspection, Staff 1 was not present.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

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 12-CC-20210517125621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 05/18/2021

NARRATIVE

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Based on evidence obtained and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 102370(d)(1) Criminal Record Clearance Type A violation is being cited.

A Civil Penalty of $1400 has been assessed during this inspection for staff criminal record clearance. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of this licensing report (LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent. A copy of the Acknowledgment of receipt of licensing report (LIC9224) was
provided and must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided to Licensee.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

LIC9099 (FAS) - (06/04)

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Citations on this Visit Report are Under Appeal!

Control Number 12-CC-20210517125621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/18/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Under Appeal Type A 05/19/2021 Section Cited CCR 102370(d)(1)	1 2 3 4 5 6 7	102370 Criminal Record Clearance (d) All individuals subject to a criminal record review... shall prior to working... in a licensed facility (1) Obtain a California clearance...as required by the Department. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee will ensure her two children obtain fingerprint clearances no later than 5/19/21. Licensee agreed to provide a declaration stating she will not permit uncleared adults into the facility during day care hours
	8 9 10 11 12 13 14	Based on observation, interview, and record review: Licensee did not ensure her adult children were fingerprint cleared prior to living at the facility and Staff 1 was fingerprint cleared before working at the facility, which poses an immediate Health and Safety risk to children in care.	8 9 10 11 12 13 14	and Licensee will not permit Staff 1 into the facility until she obtains a fingerprint clearance and is associated to the facility.
	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.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

LIC9099 (FAS) - (06/04)

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