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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417763
Report Date: 05/29/2024
Date Signed: 05/29/2024 11:09:24 AM


Document Has Been Signed on 05/29/2024 11:09 AM - 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: 8DATE:
05/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Ishara KarunaratneTIME COMPLETED:
11:25 AM
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On 5/26/2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Annual/Random inspection at the Karunaratne Family Child Care. Upon arrival, the LPA met with the licensee, Ishara Karunaratne, who guided the LPA on a facility tour. Three (3) adults (the licensee, the licensee’s husband, and the licensee’s son) reside in the home. During this inspection, 8 childcare children with the licensee. Around 9:16 am, a child arrived to the facility. LPA let the licensee know due to she has no assistant, she only can have 8 children (2 children are 5 years old, 3 children are 4 years old and 3 children are 2 years old). Per the licensee, the hours of operation are Monday through Friday, 7:30 a.m. to 5:30 p.m. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS.
The home is set up as follows:
This is a two-story, three-bedroom, and 2.5-bathroom home with a kitchen, laundry room, front and back yard, and a garage converted with a permit. It is currently the area where daycare is provided. There is no pool and spa on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows have screens free of cracks, bugs, and debris.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024
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: 05/29/2024
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Main Area: 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. Per the licensee, children only have access to the converted garage (daycare area). Children do not go inside the home.

The converted garage: LPA observed age-appropriate toys and furniture for the children in the designated childcare areas. There are mats on the floor with educational/learning activities. The mats were observed to be in good condition.

Children's bathroom (#1): The bathroom was toured and inspected, and the sink/toilet is operable. The toilet and faucets are clean. There is Tarn.x and toothbrush inside the medication cabinet without safety latch. The under the sink cabinet has a safety latch. However, the licensee did not put it on.


Backyard: The backyard was inspected; The children use the outside backyard for outside play. The backyard is gated all around. The backyard is safe for children. The backyard is completely fenced (with block cement). LPA observed age-appropriate toys, and the backyard storage shed has a lock inaccessible to children. LPA reminded the licensee that barbecue pits, lawnmowers, and other hazardous items must remain inaccessible and in limited areas while children can access the backyard.

Off-limit areas include all bedrooms, bathrooms #1 and #2, and the laundry room, which is inaccessible to children with a garage key lock. Kitchen/Dining Room (Off-limit): The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). Sharp utensils, poisons, and medications are unavailable to children in the kitchen, and child safety latches are on cabinet doors and drawers. Sharp knives are kept in a butcher block in the gated kitchen.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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: 05/29/2024
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Others:
The AC/Heating Unit and Swamp Cooler Unit were observed. The AC/Heating Unit is located on the right side of the home and inaccessible to children due to barrels blocking access. The swamp cooler unit is also inaccessible to children.
Bodies of water: Per the licensee, there are no bodies of water in the home
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green, located in the kitchen, and inaccessible to children. It meets standards established by the State Fire Marshall.
Fireplace: In the family room, a fireplace was observed that was properly screened via mirror glass doors. The fireplace is inaccessible to children.
Hanging window blind cords: The cords are inaccessible to children.
Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in the house
Medications and cleaning solutions: Detergents and cleaning compounds are in the upper kitchen cabinet, and medications are in the off-limits bedroom.
Napping: Children will not nap in the facility. The 7 children will go home at 1:30. Only 2 children will stay and they will just play in the classroom.
Overnight Care: According to the licensee, it does not provide overnight care.
Pets: No pet at the facility at this time.
Phone service: There is a working landline and cell phone
Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
Stairs (For two-story hours): A safety gate is barricaded to make the stairs inaccessible to the children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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: 05/29/2024
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The First Aid kit is in the key-locked closet, inaccessible to children. The First Aid Kit was observed to be complete with supplies and a first aid manual.
Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license, valid vehicle insurance, and vehicle registration.
Weapons or Firearms: Per the licensee, there are No Firearms at the facility at this time. LPA does not observe any firearms.
Documentation:
Child files: LPA observed that 5 children's files contained all required licensing documents.
Infant Sleeping Plan (LIC 9227) and Sleeping Log: No infant enroll at the facility.
Staff Personnel File: During an annual inspection, LPA observed 1 staff information. LPA observed, TB test. No LIC 9108, LIC 9052, Mandated Reporter Training, and CPR/First Aid certificates, No Immunization of measle, Pertussis and Influeza. The file contained all required licensing documents.
Immunization: The licensee has the required immunizations (MMR and DTaP). They also provided a written statement declining the influenza vaccination.
Criminal Record: Per Guardian, all adults who live in this facility obtain a criminal record clearance.
CPR/First Aid: LPA observed that the licensee has current Pediatric CPR and First Aid Training with an expiration date (of 3/2026) 1 hour of nutrition training and (8) hours of Preventive Health and Safety Training.
Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 6/6/2022.
Facility fees: Per the Licensing Information System, annual facility fees were current.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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: 05/29/2024
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Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 5/16/2024
LPA observed that the licensee does not posted the Earthquake Preparedness.
The following information was discussed with the licensee:
o A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
Page: 5 of 13
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: 05/29/2024
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o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family childcare home where children are present (24/7 ban).
· Family Child Care Homes Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
· IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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: 05/29/2024
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· Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
· Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
· Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.
· To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-carelicensing/ inspection-process.

Deficiencies cited: (See LIC 809D). The following Type A deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes. The licensee will have each family sign LIC 9224 (Acknowledgement of Receipt of Licensing Reports) and post the report for 30 days.

An exit interview was conducted, and the report was reviewed with the licensee, Ishara Karunaratne.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/29/2024 11:09 AM - 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: 05/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During today's inspection, LPA observed a Tarn.X Tarnish Remover in the children's bathroom withouth safety latch. The container is accessible to the childcare children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/29/2024
Plan of Correction
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After LPA talked to the licensee, the Tarn.X was removed from the children's bathroom.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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