197415930-11-29-2022-12-CC-AALH-CLMUFA-20221129143224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415930
Report Date: 11/29/2022
Date Signed: 11/29/2022 02:33:10 PM

Document Has Been Signed on 11/29/2022 02:33 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:	GUNASEKERA FAMILY CHILD CARE		FACILITY NUMBER:	197415930
ADMINISTRATOR:	GUNASEKERA,CHAMPICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 267-2654
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 9	DATE:	11/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Licensee Champica Gunasekera		TIME COMPLETED:	02:50 PM

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On 11/29/2022 Licensing Program Analyst (LPA) Alemoh met with licensee Champica who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPA observed 9 children including 1 infant in care and 2 adults caring for them. Family members residing in the home include 2 adults (licensee, licensee's husband). Facility hours of operation are Monday - Friday 6AM- 6PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the playroom and living room. The children use the bathroom located in the hallway on the left. The off-limits areas are upstairs bedrooms, two restrooms and the garage. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept in the garage, medicines are kept in (top kitchen cabinet next to the refrigerator) bedroom and hazardous items (sharp knives are kept in the kitchen in the upper cabinet high enough that they are inaccessible to children).

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (3A10BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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: GUNASEKERA FAMILY CHILD CARE	FACILITY NUMBER: 197415930
	VISIT DATE: 11/29/2022

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There is a designated area for ill children as necessary in the downstairs bedroom. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (land line).

Fire/Disaster drills are maintained current. Last fire/disaster drill was completed on 10/21/2022.

Bathroom: LPA observed properly stored cleaning compounds in a cabinet secured with a safety latch. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the garage which is locked during business hours. Breakfast, lunch, and snacks are provided. Licensee stated she currently does have a food program. Naps are provided on cots in the playroom.

Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall. There are no animals on in the premises. LPA observed age appropriate toys, well secured and safe for children. There is a gate that blocks the AC and shed making it inaccessible to children. LPA observed the swamp cooler to be covered.

There are no bodies of water on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 05/24. Mandated Reporter expires on 05/12/24. LPA reminded licensee; mandated reporter training must be completed every 2 years.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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: GUNASEKERA FAMILY CHILD CARE	FACILITY NUMBER: 197415930
	VISIT DATE: 11/29/2022

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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 not have child care insurance.

Licensee Champica 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.

LPA discussed the safe sleep regulations with licensee Champica 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.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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