197402189-2-3-2023-58-CC-LCLN-CNPLPE-20230203075550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402189
Report Date: 02/02/2023
Date Signed: 02/03/2023 07:58:49 AM

Document Has Been Signed on 02/03/2023 07:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	DE SILVA FAMILY CHILD CARE HOME		FACILITY NUMBER:	197402189
ADMINISTRATOR:	DE SILVA, DREENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 931-3266
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90019
CAPACITY:	12	CENSUS: 0	DATE:	02/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	DREENA DE SILVA, LICENSEE		TIME COMPLETED:	04:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA), Lisa Clayton, conducted an unannounced Annual inspection and was met by Licensee Dreena De Silva. There were no children in care. The facility operates Monday through Friday 8am – 5:30pm, but 24-hour care is available. Licensee provides breakfast, lunch and am/pm snacks.

LPA Clayton toured the inside and outside for a Health and Safety inspection. This is a single family home with an attic/bedroom and bathroom on the second floor. The first floor consist of the following 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, breakfast area, laundry room, and detached storage room.

The ON LIMIT areas are as follows: living room, dining room, kitchen, breakfast area, bedroom 1 (daycare room) bedroom #2, bathroom #1, fenced back yard and covered patio. The daycare room and the backyard have age-appropriate toys and furniture.

The OFF LIMIT areas are: The entire upstairs area which is inaccessible to children by a child safety gate, bedroom #3, bathroom #2, laundry room/back porch, all of which are made inaccessible by locked doors, child safety gates and supervision.

The facility has a working carbon monoxide detector and 3 working smoke detectors and a fully charged 2A:10B:C Fire Extinguisher. The home has adequate heating and ventilation for safety and comfort. The home has working telephone service and LPA confirmed the phone number is (323) 931-3266.

The Per the licensee, there are no firearms in the home. There are no swimming pools, ponds or other bodies of water on the property. Any detergents, cleaning compounds, medication, poisons and other hazardous items are made inaccessible to children.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DE SILVA FAMILY CHILD CARE HOME	FACILITY NUMBER: 197402189
	VISIT DATE: 02/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA Clayton advised licensee of the Health and Safety codes related to Mandated Reporter training as follows: 1596.8662(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter. LPA Clayton emailed the link for the Mandated Reporter training page and licensee will submit the certificate of completion no later than February 15, 2023. Licensee’s CPR/First Aid certificate expires September 2024. A review of records indicates that Licensee is in compliance with the immunization laws pertaining to childcare providers. LPA Clayton instructed Licensee to get copies of her assistant’s CPR/First Aid and Mandated Reporter certificates and immunization records (MMR, Dtap, and Flu vaccination/declination) prior to returning to work.

LPA Clayton reviewed with and printed for the Licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Incidental Medical Services (IMS) NOT being provided at this time. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. LPA Clayton provided licensee with an IMS Plan sample. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of 100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DE SILVA FAMILY CHILD CARE HOME	FACILITY NUMBER: 197402189
	VISIT DATE: 02/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies were cited today, Per Title 22, Division 12, Chapter 3, of the California Code of Regulations. Technical Assistance – Advisory Notes were issued (see LIC 9102TA).

An exit interview was conducted, a copy of this report was read and provided to the Licensee Dreena De Silva. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5