<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417763
Report Date: 06/06/2022
Date Signed: 06/06/2022 03:23:08 PM


Document Has Been Signed on 06/06/2022 03:23 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:KARUNARATNE FAMILY CHILD CAREFACILITY NUMBER:
197417763
ADMINISTRATOR:KARUNARATNE, ISHARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 718-3883
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 9DATE:
06/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ishara KarunaratneTIME COMPLETED:
03:40 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
On 06/06/22, Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee, Ishara Karunaratne, who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story, 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. There is no pool and spa on the premises. Upon arrival LPA observed 9 children in care. LPA informed licensee is over ratio at this time. LPA observed child #1 picked up at 1:24 pm. Facility is being cited a Type B Citation. Please see LIC 809-D

Family members residing in the home include 3 adults (licensee, licensee's husband, and licensee's son) . Facility operation are Monday-Friday 8:30 PM- 5:30PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the converted garage. LPA observed the approved permit from the Division of Building and Safety for the converted garage. Children use the bathroom in the converted garage near the door entrance to the home. Off limit areas include all bedrooms, bathrooms #1 #2, laundry room inaccessible to children with garage key lock. 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 (kitchen area), medicines (kitchen cabinet) and hazardous items (sharp knives in kitchen area) that can pose a danger to children. Per licensee, children only have access to the converted garage (day care area). Children do not go inside the home. There are safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises.There is a designated area for ill children as necessary in the living room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current. There is working telephone (landline/cell).
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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 5


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: 06/06/2022
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
 Last fire/earthquake drill was completed on 09/09/21. LPA reminded licensee a fire/earthquake drill must be completed and documented every 6 months, including the time and date of each drill. Facility was cited a Type B Citation. Please see LIC 809-D.

Roster is complete and maintained current.

Bathroom: Child care bathroom are free of hazards. LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in kitchen area (off limits). Snacks and lunch are provided. Per licensee, children are picked up before dinner time.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). LPA observed age appropriate toys and backyard storage shed has storage lock made inaccessible to children.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 03/12/2024. Mandated Reporter expired on 03/14/2018. LPA advised licensee to take the mandated reporter training at www.mandatedreporterca.com as soon as possible and email to LPA to show proof of completion. There are no window cords accessible to children.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 06/06/2022
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
Documents Provided and or Discussed: Child Care Ratios, Fire/Disaster Drill Log, and Mandated Reporter training. LPA discussed Safe Sleep PIN 20-24-CCP with licensee.

From interview with licensee, licensee's son is currently residing in the home. Based on record review, licensee's son has not been fingerprint cleared. Facility was cited a Type A citation. Please see LIC 809-D

Licensee was advised upon receive of this report (LIC809 and LIC809D), she must post the report along with

the notice of site visit for 30 days for parents to view. Licensee must inform the parents/guardians of children


in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12
months via form LIC 9224 Acknowledgement of Receipt of Licensing Reports. If the Licensee fails to comply a
$100.00 civil penalty shall be assessed for each family enrolled and in attendance.

Licensee Karunaratne 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's discussed the safe sleep regulations with licensee Karunaratne and discussed the Child Care Licensing Safe Sleep webpage 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.

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 Ishara Karunaratne, along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/06/2022 03:23 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
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: 06/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA observed licensee's son to be present in the home without a fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/06/2022
Plan of Correction
1
2
3
4
LPA Tamayo gave licensee's son the LIC 9163 Request for Live Scan to be completed. LPA reminded licensee her son cannot be present in the home until his finger clearance is completed while children are in care.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4

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: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 06/06/2022 03:23 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
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: 06/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review the licensee did not comply with the section cited above. After record review, last fire/disaster drill was conducted on 09/09/21, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
1
2
3
4
Licensee will conduct a fire/disaster drill no later than 06/17/22 and document time and date of drill completed.
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview,record review, the licensee did not comply with the section cited above. LPA observed 9 children in care with no assistant present, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/06/2022
Plan of Correction
1
2
3
4
LPA observed child #1 picked up at 1:24 PM. Licensee became in ratio during visit.

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: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5