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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198400678
Report Date: 02/07/2024
Date Signed: 02/07/2024 11:56:11 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator Jeanette Estrada
COMPLAINT CONTROL NUMBER: 54-CC-20231012093138
FACILITY NAME:GAMARALALAGE FAMILY CHILD CAREFACILITY NUMBER:
198400678
ADMINISTRATOR:CHANDRIKA GAMARALALAGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 325-6208
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 5DATE:
02/07/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee Chandrika Gamaralalage TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Provider did not provide adequate supervision resulting in child sustaining
multiple injuries
INVESTIGATION FINDINGS:
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This inspection was conducted on 2/7/24 by Licensing Program Analyst (LPA) Jeanette Estrada. The purpose of this inspection is to deliver findings for the above allegation for a complaint received 10/12/23. There were five children and two adults present during the inspection. Licensee provided a tour of the facility. The complaint investigation was investigated by Community Care Licensing Investigation Branch (IB), Investigator, Sonia Sandoval. IB Investigator Sandoval’s investigation consisted of interviews conducted with the Licensee and witnesses and a review of medical records from Southern California Kaiser Permanente dated 10/11/23 and 10/12/23.
The investigation revealed, on October 11, 2023, Child 1 was admitted to an Urgent Care clinic and was diagnosed with a face abrasion, face laceration with the cause of the assault being a human bite. Interviews conducted with licensee and adult 1 corroborated that Child 1 was found in the crib, crying, and had scratches on their face while Child 2 was standing next to the crib.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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 54-CC-20231012093138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GAMARALALAGE FAMILY CHILD CARE
FACILITY NUMBER: 198400678
VISIT DATE: 02/07/2024
NARRATIVE
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Per interviews, the Licensee had conducted an infant sleep check on two children, including Child 1, napping in the infant room at approximately 2 PM. The Licensee went on to the kitchen at the front of the home for a few minutes to prepare a snack, which typically took around 7 to 10 minutes, while Child 2 was in the learning room adjacent to the infant nap room. After a few minutes of preparing the snack, the Licensee inquired with Adult 1 about the whereabouts of Child 2 since they were no longer visible in the learning room. Adult 1 advised that Child 2 must have gone to use the restroom which is located in the infant nap room. Licensee entered the infant nap room and heard Child 1 crying and saw they had scratches all over their face. It was reported that parents of Child 2 inquired with Child 2 to determine what happened and Child 2 stated they scratched and pushed Child 1.Licensee notified Child 1’s parent who picked up Child 1 and took them to Kaiser Permanente Urgent Care. Comments from the physical exam noted that Child 1 had multiple abrasions on the face, neck, around nose, forehead and a possible questionable bite mark on the forehead. Based on the interview with the pediatrician, Child 1 would have cried immediately and it would have taken more than a couple of minutes for the injuries to be sustained.
Although the Licensee had conducted an infant sleep check minutes before the incident occurred, the facility failed to properly supervise child 1 and child 2. Therefore, the allegation is substantiated. The preponderance of evidence standard has been met. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC 9099D and a civil penalty of $500 is being assessed for a violation resulting in injury of a person in care.
Child 1, Child 2 and Adult 1 are identified on Confidential Names form (LIC811).The notice of site visit was posted where the parent/guardian of children enter and exit the facility. A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.
Licensee was advised that due to the severity of the complaint findings, a Non-Compliance Conference is scheduled for February 22, 2024. Licensee was also advised that a copy of this report will be provided to the Resource and Referral Agency per an agreement between CDSS and the R&R network.
Exit interview conducted and a copy of this report and appeal rights were given to the Licensee, Chandrika Gamaralalage.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20231012093138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GAMARALALAGE FAMILY CHILD CARE
FACILITY NUMBER: 198400678
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2024
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home(a)The licensee...shall ensure that children in care are supervised at all times.
This requirement was not met as evidenced by:
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Per Licensee, a plan of supervision will be provided to the Department by 2/8/24. Plan of supervision will include preparing snack after nap time, having one adult available to supervise toddler napping areas and supervising children when they use the restroom.
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Based on interviews, Child 2 was not being properly supervised when the incident occurred as there was a moment where both the Licensee and Assistant did not know where Child 2 was during nap time which poses an immediate risk to the safety of children in care.
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Type A
02/08/2024
Section Cited
CCR
102423(a)(2)
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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee: (2)To receive safe accommodations
This requirement was not met as evidenced by:
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Per Licensee, a plan of supervision will be provided to the Department by 2/8/24. Plan of supervision will include preparing snack after nap time, having one adult available to supervise toddler napping areas, one adult to supervise infant nap room
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Based on interview and record review the Licensee did not ensure that Child 1 received safe accommodations as Child 2 was able to enter the infant nap room unsupervised and cause harm which resulted in injuries to Child 1 which poses an immediate risk to the safety and personal rights to children in care.
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and supervising children when they use the restroom.
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: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3