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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413585
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:44:18 PM


Document Has Been Signed on 10/12/2022 01:44 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:NANAYAKKARA FAMILY CHILD CAREFACILITY NUMBER:
197413585
ADMINISTRATOR:NANAYAKKARA, REENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 704-7617
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:14CENSUS: 8DATE:
10/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:NANAYAKKARA, REENA - LicenseeTIME COMPLETED:
01:56 PM
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On 10/12/2022, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced Annual Required Inspection and was met by Licensee, Reena Nanayakkara. Also present was Licensees Husband (assistant). Days and hours of operation are Monday through Friday 7a-5:30p.

LPA toured the home inside and outside and a census was taken. LPA observed 8 children. Current facility sketch reviewed and Licensee confirmed that, the on limit areas include the two day care rooms located past the kitchen area. The day care area is equipped with a restroom and accessible to children in care. All other rooms are off-limits and made inaccessible by use of locked doors and supervision. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed and complete. Per LIS the facility annual fees are current. The facility roster was observed, and current. There are age appropriate toys and napping equipment on the premises. The required fire extinguisher (2A 10BC), carbon monoxide detectors and smoke detectors are in operable condition. Licensee has posted as required the License, and all other required postings in a visible location. There are no firearms or ammunition on the premises. There is no swimming pool or other bodies of water on the premises. There are no fireplaces or open face heaters in the home. There are no stairs in this home.

There are currently 3 infants in care. LPA discussed Safe Sleep Regulations with licensee and provided a copy of the Infant Safe Sleep Regulation, a sample of an infant safe sleep log, a copy of the LIC 9227, and Frequently Asked Questions regarding Infant Safe Sleep packet. Licensee immediately created and began documentation of Infant Safe Sleep. 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. The outdoor play area in the backyard is fenced and there are no hazards to children present. LPA discussed the importance of ensuring that equipment is regularly inspected, dusted off as needed and removed if broken.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
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 6


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: NANAYAKKARA FAMILY CHILD CARE
FACILITY NUMBER: 197413585
VISIT DATE: 10/12/2022
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Capacity as specified on the license is being maintained. LPA reviewed 5 children's records and observed records were missing the California Pre- Kindergarten and School Immunization Record Form. LPA provided a copy of the form to licensee and will provide proof of completion to LPA via email. Licensee’s pediatric CPR/First Aid expires on 11/21/2023. Licensee’s Mandated Reporter Training was completed in 2018 but was not renewed. LPA provided information regarding the Mandated Reported Training regulation and the requirement to complete every two years. Licensee and her Husband (assistant) will complete the required Mandated Reporter Training (AB1207) and submit proof of completion certificate to LPA via email by 10/28/2022. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. There is a dog on the premises that is kept separately from the children at all times. Immunization records are up to date. LPA provided licensee with consultation and ensured files were up to date.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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