198013602-6-18-2021-54-CC-RNAO-C44MQS-20210618094914

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013602
Report Date: 06/18/2021
Date Signed: 06/18/2021 09:49:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	DE SILVA FAMILY CHILD CARE		FACILITY NUMBER:	198013602
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	06/18/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:01 AM
MET WITH:	Shiromi De Silva		TIME COMPLETED:	10:05 AM

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	A Case Management Inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro for the purpose of increasing Licensee's capacity to 14 children. LPA was guided on a tour of the facility by Licensee Shiromi De Silva. Also present was Licensee's spouse/assistant. There were three children present during today’s inspection. Licensee states that there are currently seven children enrolled. The children's roster was reviewed and is current. Disaster drill log was also available during today’s inspection. Last drill conducted on March 2021. This is a one story home which consists of three bedrooms and two bathrooms. Areas used by the children were inspected as follows: playroom/day care area, office/napping room, one bathroom down the hallway, and back yard. Per Licensee, areas off limits to children and parents include: three bedrooms, one bathroom, living room, kitchen, front yard and garage. The outdoor play area is a fenced side yard which is free of hazards. The home was inspected for safety, comfort, cleanliness, and heating and ventilation. Per Licensee, child care will be provided 6:30am to 6:00pm Monday through Friday. There is a working telephone maintained in the home. LPA confirmed with the Licensee that all adults residing/working in the home have obtained criminal record and TB clearance. There are no pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Per Licensee, there are no weapons or firearms in the home. LPA did not observe any bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged last serviced on April 2021. Smoke and carbon monoxide detectors are in operable condition. Report Continues- Page 1 of

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 198013602
	VISIT DATE: 06/18/2021

NARRATIVE

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The Licensee and Assistant have current Pediatric First Aid and CPR, which will expire on 05/2023. Licensee and Assistant have taken the Mandated Reporter Training. Proof of immunization against pertussis, measles, and influenza was readily available during today's inspection.

The Licensee was advised they shall be present in the home and shall ensure children in care are supervised at all times. Licensee was also advised children shall not be left in parked vehicles at any time.

The bathroom was observed to be free of hazards. The home has central air and heating. Children will nap on mats and cribs in the napping room and play room. LPA informed Licensee of the new Safe sleep regulation and provided PIN 20-24-CCP for when Licensee is ready to enroll infants. The Licensee states the following as a supervision plan for infants: infants will sleep in the napping room that will be supervised at all times. LPA provided the Licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics.

The following was discussed with the Licensee/Applicant:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
· 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. The family day care home shall maintain documentation of the required immunization or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.

Report continues- Page 2 of 4

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

LIC809 (FAS) - (06/04)

Page: 2 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 198013602
	VISIT DATE: 06/18/2021

NARRATIVE

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· A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should checked and batteries replaced as needed.
· Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Incidental Medical Services (IMS) policy was discussed. 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

Report continues Page 3 of 4

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 198013602
	VISIT DATE: 06/18/2021

NARRATIVE

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LPA Provided COVID-19 Technical Assistance by emailing the Licensee COVID-19 resources and self-assessment prior to visit. LPA discussed self-assessment and answered question regarding COVID-19 procedures. Per Licensee parents will not be allowed inside the home. LPA observed sanitizer, masks and gloves. Per Applicant they will ask screening questions and take children's temperatures daily. Licensee will notify the parents in writing of exclusion and return policies pertaining to COVID-19. LPA observed Posters for parents and children informing about COVID-19 and hand washing posted in the facility. Children have their own cubby for their personal belongings.

LPA observed a dirty toy bin for toys to be sanitized at a later time. Per Licensee children and staff will wear face coverings during day care hours. Per Licensee, they will encourage 20 second hand washing with children multiple times during the day. LPA observed soap and paper towels in the bathroom. Licensee has posters that show hand washing steps for children. Licensee has a supply of cleaning and sanitizing products. Per Licensee high touched areas will be cleaned throughout the day as needed. LPA observed multiple table space for activities and meals for social distancing. LPA observed space in the main care area to socially distance children during nap time. Per Licensee they will encourage social distancing by using floor seats and pillows so a child knows how far away to sit from another child while playing. If a child becomes ill, Licensee will utilize the living room as an isolations area. LPA observed an outdoor area where child have space to play. Per Licensee, they will utilize the outdoor area for ventilation. A large family child care can have no more than 14 children at one time.

LPA advised the Licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. After further review by the department, Licensee will be notified if and when License is granted. Once licensed, the Licensee is required to adhere to the terms and limitation as stated on the license.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

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SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4