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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411895
Report Date: 11/21/2022
Date Signed: 11/21/2022 12:42:20 PM


Document Has Been Signed on 11/21/2022 12:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:ERAGODA FAMILY CHILD CAREFACILITY NUMBER:
197411895
ADMINISTRATOR:ERAGODA, GEETHA S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 259-4867
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:14CENSUS: 5DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Geetha Eragoda, LicenseeTIME COMPLETED:
01:00 PM
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On 11/21/2022 Licensing Program Analysts (LPAs) Beneroso and Villa, met with licensee, Geetha Eragoda who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPAs observed 5 children in care and 2 adults caring for them. Family members residing in the home include licensee, licensee’s husband, one adult daughter, and one adult son. Facility Operations hours are Monday through Friday, 7:00 a.m. to 6:00 p.m. Incidental Medical Services (IMS) policy was discussed.

Per licensee, daycare is provided primarily in the family room, and accessible areas of the home are living room, family room, and outdoor play area. All bedrooms, kitchen, and garage are also off limits and are kept locked during business hours. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPAs observed age appropriate safe toys and napping equipment on the premises. Per licensee children nap in the family room on mats and infants nap in cribs in the living room. Telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept in a lower kitchen cabinet with appropriate safety latches, medicines are kept in an off limits bedroom, and hazardous items (sharp knives are kept in the kitchen in the kitchen pantry).

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible, there is a designated area for ill children as necessary in the family room.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ERAGODA FAMILY CHILD CARE
FACILITY NUMBER: 197411895
VISIT DATE: 11/21/2022
NARRATIVE
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Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working land line and cell phone. Fire/Disaster drills are maintained current. Last fire/disaster drills was completed on 11/4/2022.

Bathroom: Children use the bathroom in the hallway on the left. LPAs observed toilet and faucet are clean and operable. No shampoos or other cleaning products were stored in the shower.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located under the kitchen sink with an operational safety latch which is locked during business hours. Breakfast, lunch, and snacks are brought from the children's homes. Licensee stated she currently is not a participant in a food program.

Outdoor: The front yard is off limits. The backyard is completely fenced. The backyard is used for outdoor play. The backyard is gated all around. LPAs observed a fallen tree accessible on the premises which poses a hazard to children in care. Licensee will remove the tree and provide proof of removal to LPA Villa no later than 11/28/2022. There are no pets on the premises. There are no bodies of water in the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 2/2024. Mandated Reporter expires on 3/4/2024. LPAs reminded licensee mandated reporter training must be completed every 2 years by every employee. Licensee will instruct staff to take the Mandated Reporter Training and send proof of completion to LPA VIlla no later than 11/21/2021.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have childcare insurance.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ERAGODA FAMILY CHILD CARE
FACILITY NUMBER: 197411895
VISIT DATE: 11/21/2022
NARRATIVE
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Licensee Eragoda 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.

LPAs discussed the safe sleep regulations with licensee Eragoda 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. LPAs 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.


A notice of site visit was given to licensee and must remain posted 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 the licensee Eragoda along with her appeal rights.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ERAGODA FAMILY CHILD CARE
FACILITY NUMBER: 197411895
VISIT DATE: 11/21/2022
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LPAs discussed the safe sleep regulations with licensee Eragoda 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. LPAs 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.


A notice of site visit was given to licensee and must remain posted 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 the licensee Eragoda along with her appeal rights.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 11/21/2022 12:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: ERAGODA FAMILY CHILD CARE
FACILITY NUMBER: 197411895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, the licensee did not comply with the section cited above in a fallen tree in Licensee's backyard, accessible to children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will completely remove the fallen tree from the premesis and send proof of completion to LPA Villa no later than November 28, 2022.
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on employee record review, the licensee did not comply with the section cited above in one out of one files reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2022
Plan of Correction
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Licensee will have employees complete the required personnel forms and trainings and keep copies in the official personnel folder at the facility. Corrections are due no later than 11/23/2022.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 5 of 8