197419620-5-18-2022-12-CC-JDOY-CEJQJ3-20220518121204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419620
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:12:21 PM

Document Has Been Signed on 05/18/2022 12:12 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:	GARUSINGHE FAMILY CHILD CARE		FACILITY NUMBER:	197419620
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	05/18/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Kushani Garusinghe		TIME COMPLETED:	12:26 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 05/18/2022, Licensing Program Analysts (LPA's) Justin Dorsey and Justeene Tamayo conducted an Capacity Increase Pre-Licensing inspection with Licensee, Kushani Garusinghe to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety requirements. The Licensee is requesting to provide care for a Large family childcare home for the capacity of 14 children. Currently, there are 3 adults (Licensee and two other adults) and one child living in the home. LPA toured the home indoor and out to ensure it meets FCCH requirements. The Licensee is requesting the days and hours of operation will be Monday through Friday 7:00am - 5:30pm. The home is described as follows: This is a two story home with 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, familyroom, laundry room, office and garage. The home has central heating and air conditioning. Indoor: Main area: Main care is provided in the converted dining room. Children use the bathroom in the hallway near the laundry room and office. Children have access to the main care area (converted dining room), dining area (in kitchen), family room, downstairs bathroom #1 and backyard. Bathroom #1: Children will use the bathroom #1 near the laundry room. The bathroom #1 was toured, and inspected, toilets are in operable condition. Toilet and faucets are clean, safe, and operable; shower area is free of hazard. There are no medications storage in the medicine cabinet. Kitchen: Sharp utensils, cleaning supplies, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are inaccessible to children. The refrigerator dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. All lower cabinets in the kitchen have child locks. Medications are stored in off-limit bedrooms.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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

FACILITY NAME: GARUSINGHE FAMILY CHILD CARE	FACILITY NUMBER: 197419620
	VISIT DATE: 05/18/2022

NARRATIVE

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Outside: The backyard was inspected. The backyard is completely fenced children will play outside in the backyard. There is grass, sand and concrete for children to play. LPA observed toys and play equipment in good condition. LPA observed an off-limits area on the right side of the backyard. LPA's observed the area was barricaded by a plastic children's fence.

Off-limit area:
Upstairs area: LPA observed a gate to keep children from accessing the stairs.
Living room: Per licensee the living room is off-limits to children.
Laundry room: There is a door which makes this area inaccessible to children.
Garage: Garage is accessed through the laundry room and no child care activities will be conducted there.
·Other:
Napping equipment (6 mats & 2 cribs): Per licensee children nap in the main care area, LPA reminded licensee that children must be supervised when sleeping. Per Licensee there is 1 infant enrolled at the home. LPA Dorsey gave a copy to and went over PIN 20-24-CCP with the licensee.
Electrical outlets: All unused electrical outlets are made inaccessible to children.
There is a First Aid kit located in the children's bathroom #1.
Weapons or Firearms: Per The Licensee, there are no weapons or firearms. LPA did not observe any weapons or firearms.
Cleaning compounds are stored under the sink and made inaccessible by a safety latch. LPA Dorsey advised licensee to replace the latch due overuse.
Smoke detector and a carbon monoxide detector tested operable.
Fire extinguisher (2A10BC) There is a fully charged fire extinguisher (2A10BC); which meets fire marshal standards.

Documentation:

The Licensee has current CPR, First Aid Training with the expiration dates of 07/2022. LPA Dorsey was unable to find the Prevented Health and Safety Training in the licensees file and licensee did not have a copy. According to the pre licensing visit conducted 11/04/14 the training was completed 07/27/14. LPA advised licensee to retake the course to include nutrition and lead training. The Licensee has her fingerprint clearance and TB exam. The Licensee has proof of being immunized against pertussis, and measles. The Licensee has proof of Mandated Reporting Training dated 05/16/2022. Per licensee, she occasionally provides transportation. Per Licensee breakfast, AM snack, Lunch and PM snack are provided for children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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

FACILITY NAME: GARUSINGHE FAMILY CHILD CARE	FACILITY NUMBER: 197419620
	VISIT DATE: 05/18/2022

NARRATIVE

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The following was discussed with The Licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills, and documentation for both. Role and responsibilities of being a mandated reporter.

The Licensee reminded that 100% supervision is required at all times to children in care. The Licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. The Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified

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 day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

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 childcare homes shall post during hours of operation. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) 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 shall receive an influenza vaccination between August 1 and December 1 of each year

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: GARUSINGHE FAMILY CHILD CARE	FACILITY NUMBER: 197419620
	VISIT DATE: 05/18/2022

NARRATIVE

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Incidental medical Services (IMS) policy was discussed. The Licensee will wait until facility opens to determine IMS needs. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 http://www.ada.gov/childqanda.htm

Safe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep. During the visit LPA Dorsey gave a copy to and went over PIN 20-24-CCP with licensee.

Upon receipt of the Licensees Preventative Health and Safety Training Certificate LPA Dorsey will submit capacity increase application to LPM.

An exit interview was conducted, Appeal Rights and Notice of Site Visit were given and the report was reviewed with Licensee Garusinghe.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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