334840727-5-12-2022-10-CC-CMAZ-CFCPUX-20220613113814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334840727
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:55:55 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2022 and conducted by Evaluator James Wilkerson

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20220126113140

FACILITY NAME:	JAYASINGHE FAMILY CHILD CARE		FACILITY NUMBER:	334840727
ADMINISTRATOR:	JAYASINGHE, RANJANI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 746-3256
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92584
CAPACITY:	14	CENSUS: 6	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Ranjani Jayasinghe		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) James Wilkerson & Jessica Rubio arrived at this facility to notify the licensee that the investigation into the above-allegation has been completed. The following is the finding based on the investigation report of Community Care Licensing, Investigations Branch Investigator Brittany Hudec. It was determined from a forensic intervew with the Menifee Police Department that Staff #1 (S1) had kissed Child #1(C1) and licked C1's lip. It was disclosed that S1 kissed C1 with S1's tongue..

Based on this information received from this investigation, a preponderance of evidence has been met.

SEE LIC 9099D for deficiency cited.

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 for the next 12 months. SEE LIC 9099C for continuance of this report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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 3

Control Number 10-CC-20220126113140

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: JAYASINGHE FAMILY CHILD CARE	FACILITY NUMBER: 334840727
	VISIT DATE: 05/12/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

An exit interview was conducted, Notice of Site Visit posted, appeal rights discussed and given to the licensee along with a copy of LIC 9224 (AB 633) and a copy of this report was provided to the facility on this date.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 10-CC-20220126113140

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: JAYASINGHE FAMILY CHILD CARE	FACILITY NUMBER: 334840727
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/13/2022 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: (1)To be accorded dignity in his/her personal relationships with staff and other persons. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her	1 2 3 4 5 6 7	Licensee, Ranjani Jayasinghe agrees to contact the Riverside Office of Education (RCOE) for training, to focus on Personal Rights. Licensee agrees to submit confirmation of this scheduled training is to be sent to Community Care Licensing by 05/12/22.
	8 9 10 11 12 13 14	needs. This requirement was not met as evidenced by a substantiated complaint finding were S1 kissed C1 and licked C1's lip and S1 kissed C1 with S1's tongue. This poses an immediate risk to the health and safety of the children.	8 9 10 11 12 13 14
	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: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3