304371421-4-12-2021-06-CC-RLOZ-BZZVQR-20210412163847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371421
Report Date: 04/12/2021
Date Signed: 04/12/2021 03:23:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2020 and conducted by Evaluator Mila Quinto

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20201201134429

FACILITY NAME:	MAGICAL STAR MONTESSORI-PRESCHOOL		FACILITY NUMBER:	304371421
ADMINISTRATOR:	VITHANAGE, IRA DAYANI		FACILITY TYPE:	830
ADDRESS:	1636 WEST CATHERINE DRIVE		TELEPHONE:	(714) 696-1241
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	20	CENSUS: 5	DATE:	04/12/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Diyani Vithanage		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff had different stories as to how the daycare child was injured.

INVESTIGATION FINDINGS:

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***A Tele Investigation due to COVID-19 State of Emergency***
Licensing Program Analyst (LPA), Mila Quinto conducted a tele investigation visit to the facility to deliver the finding of the complaint initiated on 12/01/2020 regarding the above allegation. LPA met with Director, Dayani Vithanage via facetime. The Covid-19 Emergency Response questionnaires were asked. LPA observed 5 napping infants and 1 staff.

A review of facility personnel report summary on this date (4/12/21) indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The complainant alleged a staff member had different stories on how the daycare child was injured. On 12/07/2020, LPA interviewed the director regarding the allegation of different stories as to how the daycare child was injured.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mila Quinto	TELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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 06-CC-20201201134429

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MAGICAL STAR MONTESSORI-PRESCHOOL	FACILITY NUMBER: 304371421
	VISIT DATE: 04/12/2021

NARRATIVE

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The director stated the incident took place towards the end of the day, right before the child was picked up by the parent. Upon arrival, the parent inquired about the dried blood on the child’s nose and director asked the infant teacher who stated the child fell shortly before pick up time. Due to the short time period of the incident and pick up time, the infant staff member did not have an ouch report to provide the parents. However, the infant staff member informed another staff who was taking the child to the front for pick up to inform the parent of the incident. On 4/12/21, LPA interviewed 3 staff members which includes the director. One staff was not at the facility when the incident took place. The 2 staff stated the child fell while playing with a ball right before the parent arrived for pick up. The director stated due to the time period, the parent was verbally informed during pick up and a written notice was not provided the next day. Children were not interviewed due to children being nonverbal.

Based on the interviews with 3 staff members including the Director of which 2 indicated the child fell down when playing with a ball shortly before pick up time. There was not enough evidence to substantiate the allegation of staff had different stories as to how the daycare child was injured; although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the staff had different stories on how the daycare child was injured, therefore the allegation is unsubstantiated.

Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. (The "Read Receipt" or licensee's email is in lieu of a signature). First level appeal is to Regional Manager, address is above on the report.

Exit interview was conducted.

Report ends here.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mila Quinto	TELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

LIC9099 (FAS) - (06/04)

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