197492752-7-9-2024-30-CC-VWHY-D6ZSQS-20240709140513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197492752
Report Date: 07/09/2024
Date Signed: 07/09/2024 02:05:24 PM

Document Has Been Signed on 07/09/2024 02:05 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	FERNANDO FAMILY CHILD CARE		FACILITY NUMBER:	197492752
ADMINISTRATOR:	SHIROMI FERNANDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 532-7529
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	14	CENSUS: 7	DATE:	07/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Shiromi Fernando		TIME COMPLETED:	02:15 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 July 9, 2024, Licensing Program Analyst (LPA), V. Wheatley conducted an Annual Inspection and was met by Licensee Shiromi Fernando. The licensee's assistant was present. The licensee is operating days and hours of operation are Monday through Friday, 7am to 6pm. Parents and children enter through the side of the home. LPA toured the home inside and outside and a census was taken. LPA observed 7 day care children present today. Capacity as specified on the license is being maintained. Current facility sketch reviewed and confirmed that the family room, dining room and kitchen are used for providing care to children. All other rooms are off-limits and made inaccessible. Detergents, cleaning compounds, medication and other hazardous items in the kitchen and in the bathroom are made inaccessible. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and air condition for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. Bedding is kept separate and laundered by the licensee. The home has working telephone service and LPA confirmed the phone number. LPA observed a children's roster. LPA discussed Safe Sleep Regulations with licensee. Cribs and play yards will be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPA observed 4 infants in care today. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FERNANDO FAMILY CHILD CARE	FACILITY NUMBER: 197492752
	VISIT DATE: 07/09/2024

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

LPA reviewed children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expired 6/2024. Licensee’s pediatric CPR/First Aid expires 9/2025. A review of records indicates that all employees and/or volunteers do have immunization records on file for influenza, pertussis and measles.

The children play in the backyard which is fenced. LPA observed several toys and equipment. LPA did not observe any bodies of water. There are no pets on the premises. Licensee states there are no firearms on the premises.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted. A copy of the report provided to the licensee.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3