376701178-10-21-2021-10-CC-PBER-C8FS82-20211104133824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376701178
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:21:55 PM

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
10/05/2021 and conducted by Evaluator Andrea Taylor

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20211005145601

FACILITY NAME:	PINK TOWER MONTESSORI-INFANT		FACILITY NUMBER:	376701178
ADMINISTRATOR:	JAYASINGHE, CHANDANI		FACILITY TYPE:	830
ADDRESS:	203 LAURINE LANE		TELEPHONE:	(760) 728-4754
CITY:	FALLBROOK	STATE: CA	ZIP CODE:	92028
CAPACITY:	12	CENSUS: 11	DATE:	10/21/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Chandani Jayasinghe-Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Infants were sleeping with blankets over their heads.

INVESTIGATION FINDINGS:

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The purpose of this inspection was to conduct a Complaint Investigation of the facility. On 10/5/21 a complaint was filed with the Licensing office.
LPA and Licensee Chandani Jayasinghe, toured the facility, inside and out.
There were 11 infants and 3 staff present during this inspection.

During previous inspection (10/11/21) LPA Taylor obtained a current children’s roster, a current Personnel Report (LIC500), interviewed staff.

All person's pertient to the investigation were interviewed stating that no infants ever sleep with a blanket over the infants face. LPA did not observe any infants with blankets over their face.
LPA Taylor reviewed the Safe Sleep Regulations with the staff and the Licensee at length during visit.
LPA Taylor gave the Licensee information on how to look up the regulations on the Department's website.
Licensee has trained the staff on all Safe Sleep Regulations.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea Taylor	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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 10-CC-20211005145601

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: PINK TOWER MONTESSORI-INFANT	FACILITY NUMBER: 376701178
	VISIT DATE: 10/21/2021

NARRATIVE

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In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) 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. 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 $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea Taylor	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC9099 (FAS) - (06/04)

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