197417763-3-12-2020-12-CC-NFLS-BMN2AK-20200312171341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417763
Report Date: 03/12/2020
Date Signed: 03/12/2020 08:36:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	KARUNARATNE FAMILY CHILD CARE		FACILITY NUMBER:	197417763
ADMINISTRATOR:	KARUNARATNE, ISHARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 718-3883
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	14	CENSUS: 8	DATE:	03/12/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Ishara Karunaratne		TIME COMPLETED:	05:25 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) Nadia Flores met with licensee, who granted access into the home. The purpose of the inspection is to conduct an Annual Inspection. Licensee is licensed to provide care and supervision for a Large family child care with the capacity of 12-14 children. Licensee states 14 children are enrolled in the family child care. Present during the time of this inspection is licensee, 8 family child care children along with assistant who is licensee's daughter. Currently residing in the home, is the licensee, licensee's spouse and children. Licensee states she does not care for infants. Home is 3 bedroom and 2.5 bathrooms, with a kitchen, laundry room, front and back yard and a garage which was converted and is currently the area where day care is provided. Licensee and LPA toured the area of the home designated to the day care, inside and outside play area to insure the home is kept clean and orderly, with heating and ventilation for safety and comfort. LPA observed the home to have no bodies of water on the premises. All poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children were observed to be inaccessible to children secured with child safety latch on the cabinets in bathroom. Licensee smoke/carbon monoxide detector was tested and appear to be in operable condition. The licensee provides safe, healthful, accommodations, furnishings, equipment, safe toys, play equipment and materials for the children in care.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (616) 568-8970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KARUNARATNE FAMILY CHILD CARE	FACILITY NUMBER: 197417763
	VISIT DATE: 03/12/2020

NARRATIVE

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Licensee is aware the home shall maintain capacity specified on the license. Licensee states no transportation is provided for children in care however licensee is aware children shall not be left in parked vehicles and proper equipment is used at all times.

The licensee provided copy of current roster of the children in care. Licensee last fire and disaster drills were conducted on 11/2019. Licensee is aware the above drills shall be conducted every six months and documents the date and time of each drill. Licensee provide child’s parent or representative with a copy of the family child care home Notification of Parents’ Rights, Licensee is aware to document immunizations, update and maintains records for child in care.

Licensee is aware the Licensee and a person to reside, be employed or volunteer at a family day care home shall be immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination Between, August 1 and December 1 of each year.

Licensee is aware about preventive health practices including pediatric CPR and First Aid shall be completed by licensee and other personnel. CPR expires 10/2020. The licensee shall complete the online mandated reporter training at www.mandatedreporterca.com All child care employees must complete mandated reporter training within 30 days of hire and renew training every two years

Incidental Medical Services (IMS) were discussed. The facility is not providing IMS at this time.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (616) 568-8970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KARUNARATNE FAMILY CHILD CARE	FACILITY NUMBER: 197417763
	VISIT DATE: 03/12/2020

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The following forms or information was discussed with the licensee:
• Licensee is reminded that 100% supervision is required to children at all times.
• The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.
• Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care.
• The licensing department must have the facility’s phone number at all times; if the phone number is changed, the licensing department must be notified.
• Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation.
**In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.
• The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.
• Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty
• Licensee advised visit www.shotsforschool.org for Immunization information.
• Child Care Advocates: www.childcareadvocatesprogram@cdss.ca.gov
• LPA provided licensee handout” FORMS/RECORDS TO KEEP IN YOU FAMILY CHILD CARE HOME.

Deficiencies cited: (See LIC 809D). The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes.

Exit interview conducted with Licensee. A copy of this report is discussed and left with licensee.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (616) 568-8970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KARUNARATNE FAMILY CHILD CARE	FACILITY NUMBER: 197417763
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/20/2020 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home - Fire extinguishers and smoke detectors shall meet State Fire Marshal standards. This requirement is not met as evidenced by: Licensee's Fire extinguisher was in red and was the wrong size. The LPA observed a fire extinguisher smaller (1A10BC) than the required (2A10BC).
	8 9 10 11 12 13 14	Having a smaller fire extinguisher does not meet regulation, which is a potential risk to health and safety of children.	8 9 10 11 12 13 14
Type B 04/17/2020 Section Cited	1 2 3 4 5 6 7	Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer
	8 9 10 11 12 13 14	shall receive an influenza vaccination between August 1 and December 1 of each year. Licensee did not meet regulation by evidence that 3 of the staff files do not include proof of immunizations.	8 9 10 11 12 13 14

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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (616) 568-8970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

LIC809 (FAS) - (06/04)

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