197417763-6-28-2023-12-CC-JTAO-CT8QXD-20230628123323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417763
Report Date: 06/28/2023
Date Signed: 06/28/2023 12:33:31 PM

Document Has Been Signed on 06/28/2023 12:33 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
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:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Ishara Karunaratne, Licensee		TIME COMPLETED:	12:50 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 06/28/2023, Licensing Program Analyst (LPAs) Justeene Tamayo and Evelyn Garcia 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 4 school age and 4 preschool children in care. Family members residing in the home include 3 adults (licensee, licensee's husband, and licensee's son) . Facility operation are Monday-Friday 8:30 AM- 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 Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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: 06/28/2023

NARRATIVE

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Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster drill was completed on 06/10/2023

Roster is complete and maintained current.

Bathroom: Child care bathroom are free of hazards. LPAs 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). LPAs observed age appropriate toys and backyard storage shed has storage lock made inaccessible to children. LPAs reminded licensee barbecue pits, lawn mowers, and other hazardous items must remain inaccessible and in off limits area while children have access to the backyard.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 03/12/2024. Mandated Reporter expired on 06/04/2024. There are no window cords accessible to children.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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: 06/28/2023

NARRATIVE

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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.

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.

LPAs 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. LPAs 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 and Notice of Site Visit.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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