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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198401330
Report Date: 09/17/2025
Date Signed: 09/18/2025 07:12:08 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
09/11/2025 and conducted by Evaluator Alicia Mooberry
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20250911133005
FACILITY NAME:KEERTHISINGHE FAMILY CHILD CAREFACILITY NUMBER:
198401330
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Harshani Keerthisighe, ResidentTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Unlicensed Care being provided
INVESTIGATION FINDINGS:
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An unannounced complaint inspection was conducted on this day by Licensing Program Analyst (LPA) Alicia Mooberry regarding the allegation above. LPA met with Harshani Keerthisighe, Resident, and explained the purpose of visit. Per record review, there is a pending application for a Small Familiy Child Care license submitted by Harshani Keerthisighe (Applicant) to the department. The Applicant guided LPA on a tour of rooms where children are receiving care. LPA observed 6 children in the home including 2 infants receiving care and supervision from Applicant. LPA observed Child 1 (age 22 months ) laying in baby bouncer in Bedroom 1. LPA discussed the need to provide a safe environment. LPA informed Harshani Keerthisighe that continued operation of the unlicensed family child care home may pose an immediate risk to the health and safety of children in care.
Based on LPA observations, Licensee Interview and documents reviewed, it has been determined that the applicant Harshani Keerthisighe is in violation of Section 1596.80 of the Health & Safety Code which prohibits operation of a child care facility in this state without a license. Therefore, the complaint allegation of unlicensed care being provided is Substantiated. ------- Page 1 Report Continues
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Warren Birks
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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 2
Control Number 54-CC-20250911133005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KEERTHISINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198401330
VISIT DATE: 09/17/2025
NARRATIVE
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Harshani Keerthisighe has submitted an application for a family child care license to Community Care Licensing and is pending approval.

LPA informed Applicant that she must cease her operation of providing non-exempt care and supervision to children without a license, and failure to comply will result in the assessment of civil penalties in the amount of $200.00 per day.



Per Applicant, they will only care for 1 family in addition to they own children until the license is approved.

LPA provided the Resource & Referral Network number (800)543-7793 to Applicant to contact for information.

A Notice of Violation of the law letter (LIC195) was issued to Harshani Keerthisighe, Applicant

Exit interview conducted with Harshani Keerthisighe, signature on this report acknowledges receipt of licensing report.
SUPERVISORS NAME: Warren Birks
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2