198017986-7-15-2020-33-CC-BBEL-BRJVML-20200715163345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017986
Report Date: 07/15/2020
Date Signed: 07/15/2020 04:34:12 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KARUNARATNE FAMILY CHILD CARE		FACILITY NUMBER:	198017986
ADMINISTRATOR:	KARUNARATNE, DEEPANI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 221-6485
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	14	CENSUS: 2	DATE:	07/15/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee Deepani Karunaratne		TIME COMPLETED:	04:30 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	Licensing Program Analyst (LPA) Emiko Bell contacted the facility on 07/15/20 via FaceTime on the telephone due to COVID-19 and precautionary measures in order to conduct an unannounced follow-up Case management inspection. The purpose of the inspection is to ensure that the corrections recommended during the 07/14/20 inspection have been completed. Census: There was one other adult (who was in the bedroom the duration of the inspection) and two children present. During today's inspection, licensee showed LPA with a tape measure that there is now three feet of space between the bed and the crib and the bed and the playpen in bedroom #1. Licensee understands that all who sleep in this room during naptime will have to ensure a head-to-toe configuration as there is only three feet of space. In addition, licensee showed LPA that the pieces of wood have been removed from the left side gate area. Lastly, licensee showed LPA that a baby gate has been placed between the back yard and the side gate area and a baby gate has been placed around the air-conditioning unit in an effort to render the air-conditioning unit inaccessible. Furthermore, licensee explained that as the side Page 1/2

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2020

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KARUNARATNE FAMILY CHILD CARE	FACILITY NUMBER: 198017986
	VISIT DATE: 07/15/2020

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gate is kept latched from the inside, in order for a parent to enter through the side gate, she would have to go and physically open the gate, and she would either let the parent in or would take the child and physically accompany them to the gate, thus ensuring supervision when the children were around the air-conditioning unit.

Based upon the observations made during today's tele-inspection, removing bedroom #1 from "off-limits" to an area which will used by the daycare children and permitting the parents to enter through the side gate is approved with the condition that until the air-conditioning unit is completely rendered inaccessible to children, adult supervision of children will always be required when the children are near the air-conditioning unit.

An exit phone interview has been conducted with Licensee Deepani Karunaratne. This report has been signed by LPA Bell.

This report will be scanned via e-mail to Licensee Karunaratne, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature.

A hard copy of this report has been placed in today’s mail and Licensee Karunaratne agrees to sign the bottom of each page of the 809 and return the originals to LPA Bell in-person or via U.S. Mail.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2020

LIC809 (FAS) - (06/04)

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