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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197750171
Report Date: 01/19/2024
Date Signed: 01/19/2024 03:52:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 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
10/26/2023 and conducted by Evaluator Andrew Alemoh
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20231026093145
FACILITY NAME:MY SUNSHINE MONTESSORI PRESCHOOLFACILITY NUMBER:
197750171
ADMINISTRATOR:SHAN SILVAFACILITY TYPE:
850
ADDRESS:18045&47 SIERRA HWYTELEPHONE:
(661) 252-6422
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:65CENSUS: 5DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Director Kumuduni TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff #1 pinched child #1.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/19/2024 at 1:45PM, Licensing Program Analyst (LPA) Andrew Alemoh met with Director Kumuduni for the purpose to deliver the finding of the above allegation. Upon arrival, LPA observed 6 preschool age children with director and 1 staff.

The investigation consisted of interviews with licensee, parents, other complaint relevant parties including review of pertinent records and other additional information. The interviews conducted revealed: child #1 was not pinched by staff #1. Child #1 statements did not corroborate with the allegation. Based on the evidence obtained there are inconsistent statements therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report along with the appeal rights was provided to the licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
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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