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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198021544
Report Date: 06/05/2026
Date Signed: 06/05/2026 11:06:09 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2026 and conducted by Evaluator Diana Ortiz
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20260316083142
FACILITY NAME:EDIRIMUNIAND ABEYSEKARA FAMILY CHILD CAREFACILITY NUMBER:
198021544
ADMINISTRATOR:EDIRIMUNI,TENURIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 680-7604
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:14CENSUS: 5DATE:
06/05/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Licensee did not provide adequate supervision, resulting in a day care infant sustaining injury
Licensee did not report unusual incident to the authorized representative of a day care infant
INVESTIGATION FINDINGS:
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On 06/05/26 at 8:30am, Licensing Program Analyst (LPA) Diana Ortiz conducted an unannounced complaint inspection to investigate the above allegations. LPA met with Licensees Assistant Asanka White, who stated Licensee Deshika Abeysekara and Licensee Tenuri Edirimuni were both out of town. LPA then explained the purpose of the visit. LPA was guided on a tour of the facility. A census was taken, during which five (5) children were observed present.

The allegations stated that (1) the Licensee did not provide adequate supervision, resulting in a daycare infant sustaining injury, and (2) the Licensee did not report the unusual incident to the authorized representative of a daycare infant.

As part of the investigation, LPA conducted interviews with Licensee #1 (L#1), Licensee #2 (L#2), and two (2) daycare parents.
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Diana Ortiz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
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 4
Control Number 33-CC-20260316083142
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EDIRIMUNIAND ABEYSEKARA FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 06/05/2026
NARRATIVE
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LPA also reviewed the LIC 9040 Facility Roster, parent handbook, staff and children files, and obtained photographs of the play area, including the brick structure where the alleged incident occurred.

The Reporting Party (RP) stated that on 03/11/26, they picked up their child at approximately 3:45–4:00 PM and were informed that the child had fallen earlier in the day, approximately between 12:30–1:00 PM. The RP stated they were not notified at the time of the incident and observed visible injuries to the child’s mouth and chin. The RP reported that the child received urgent care and a dental evaluation, which indicated dental trauma requiring follow-up treatment. The RP expressed concern regarding delayed notification and the absence of observed safety barriers in the play area.

Licensee #1 (L#1) confirmed that the infant sustained an injury while playing in the daycare play area after losing balance and striking a brick structure. L#1 reported that she was attending to another child at the time of the incident and observed the child lose balance and strike the brick structure. L#1 acknowledged that the parent was not notified immediately and stated the parent was informed at pick-up. L#1 reported that she did not contact the parent at the time of the incident due to the anticipated pick-up time and completed an incident report for the facility file.

Licensee #2 (L#2) reported that while she went to the restroom, the child lost balance and fell and hit his chin on the brick structure located in the daycare room. L#2 reported that first aid was provided, including ice application, pressure to the injury, and rinsing of the child’s mouth. L#2 stated the child was monitored following the incident and later resumed normal activity. L#2 confirmed that only L#1 and L#2 were supervising at the time of the incident and that notification to the parent occurred at pick-up due to how close it was to the end of the day.

Parents interviewed did not disclose any concerns with the daycare.

During the inspection, LPA observed that the brick area was covered with foam padding and carpet material. Photographs were taken to document the condition of the play area.


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Diana Ortiz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20260316083142
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EDIRIMUNIAND ABEYSEKARA FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 06/05/2026
NARRATIVE
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This agency has investigated the complaint alleging that (1) the Licensee did not provide adequate supervision, resulting in a daycare infant sustaining injury, and (2) the Licensee did not report the unusual incident to the authorized representative of a daycare infant. Based on LPA’s observations, interviews conducted, and record review, the preponderance of evidence standard has been met; therefore, the allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC 9099D page. Deficiencies cited must be cleared to protect the health and safety of children in care.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Assistant, Asanka White.


















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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Diana Ortiz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20260316083142
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EDIRIMUNIAND ABEYSEKARA FAMILY CHILD CARE
FACILITY NUMBER: 198021544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2026
Section Cited
CCR
102416.2(f)(1)
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102416.2(f)(1)Reporting requirements
As soon as possible...the licensee shall notify a child's parent or authorized representative regardless of the injuries... (1)Any injury suffered by a child in care shall be reported to that child's parent or authorized representative regardless of
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Per Licensee and Licensees Assistant, they will provide declarations stating they need to report any incident right away to parents or authorized representative and submit to LPA by POC due date.
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 treatment by a medical professional.
This regulation was not met as evidenced by:
The parent was not notified of Child #1s injuries until pick up time (3:45pm-4pm). RP was told injury occured at approximately 12:30pm-1pm.
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Type B
06/19/2026
Section Cited
CCR
102423(a)(2)
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102423(a)(2) Personal Rights
Each child receiving services from a family child care home shall have certain rights...(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This regulation was not met as evidenced by:
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Per licensee, since the injury, the brick structure is now covered foam padding and carpet material. There is also two (2) wooden structures on top of the brick. Pictures were taken.
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Child #1 fell and hit his chin on the brick structure located in the daycare room. The brick structure was exposed and there was no padding surrounding the brick structure.

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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.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Diana Ortiz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC9099 (FAS) - (06/04)
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