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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845781
Report Date: 11/09/2023
Date Signed: 11/09/2023 12:30:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2023 and conducted by Evaluator Elyse Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230918104744
FACILITY NAME:KUMARAPPERUMA FAMILY CHILD CAREFACILITY NUMBER:
334845781
ADMINISTRATOR:KUMARAPPERUMA,MARIAN SHERMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 207-2848
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:14CENSUS: 9DATE:
11/09/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Marian Kumarapperuma, LicenseeTIME COMPLETED:
12:38 PM
ALLEGATION(S):
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Day care child sustained unexplained injuries
Licensee left day care child soiled in feces
INVESTIGATION FINDINGS:
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On November 9 2023, Licensing Program Analysts (LPAs) Elyse Jones and Blanca Ruiz arrived at the facility to the investigation regarding the above allegations. During the investigation, LPAs toured the facility, interviewed pertinent parties, and collected documentation.

On September 18, 2023, a complaint was received alleging Licensee left day care child soiled in feces and a child sustained unexplained injuries while in care. During interviews, the Licensee stated the child was often sent to day care with injuries and was never sent home with bite marks or bruises the child did not come with. Licensee stated the child was being worked with on potty training and no child has been sent home soiled. Licensee stated all children are changed when they wake up from naps, before being picked up, and as needed throughout the day.

LPA requested documentation of soiled clothing or any side effects from being sent home in soiled clothing was requested but never received.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
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 09-CC-20230918104744
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KUMARAPPERUMA FAMILY CHILD CARE
FACILITY NUMBER: 334845781
VISIT DATE: 11/09/2023
NARRATIVE
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Due to conflicting statements given during interviews with pertinent parties, the Department is unable to determine if the injury occurred while in care or if a child was sent home in soiled clothing.

This agency has investigated the complaint regarding the above allegation. Based on the interviews conducted, the allegations are UNSUBSTANTIATED. A finding of unsubstantiated means, although the allegations may have happened, or are valid, there is not a preponderance of the evidence to prove the allegations occurred.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door 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 Marian Kumarapperuma, Licensee.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4