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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019361
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:15:25 PM


Document Has Been Signed on 08/22/2023 12:15 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:KARIYAKARAWANA FAMILY CHILD CAREFACILITY NUMBER:
198019361
ADMINISTRATOR:SANGEETHA KARIYAKARAWANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 256-9910
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 7DATE:
08/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee Sangeetha Kariyakarawana TIME COMPLETED:
12:20 PM
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On 8/22/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1-year inspection at the above facility. LPA met with the Licensee Sangeetha Kariyakarawana and informed her of the purpose for the visit. Licensee was provided a copy of the Facility Entrance Checklist. There were 7 children and an additional assistant provider present during the inspection. The facility was in compliance with capacity requirements for a large fcch. All residents were noted and verified. Facility provides care to children ages 0 to 6 years 6:30AM to 6:30 PM Monday through Friday.
This is a two story, four-bedroom, three-bathroom home.
Per Licensee areas off limits to children are: The entire second floor which consists of three bedrooms and two bathrooms, the kitchen and the garage. LPA observed a safety gate installed at the bottom of the stairs on the first floor. The garage, accessible on the first floor, is maintained locked.
Per Licensee areas on limits to children are: One bedroom on the first floor used as the main day care area, the dining room and the backyard. The living room is on limits in passing to the day care room but it is not used for day care purposes.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation- Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed and reviewed a current roster LIC 9040. There is disaster drill log available for review. The last documented drill was conducted on 7/28/23. LPA observed an operable combination carbon monoxide/smoke detector in the kitchen area. LPA observed a 2A10BC Fire Extinguisher in the day care which was serviced in July 2023 as indicated on the service tag. The home maintains telephone service ( cell phone). Children bring food from home. Children’s lunches are kept in their labeled lunch bags and containers. There are toys and other age -appropriate materials available for children to use in the day care room. Sharp objects, detergents and cleaning compounds were inaccessible to children in care.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KARIYAKARAWANA FAMILY CHILD CARE
FACILITY NUMBER: 198019361
VISIT DATE: 08/22/2023
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Per Licensee, knives are kept in the garage, cleaning products are stored in a latched cabinet under the sink, detergent is also kept in the garage. Personal medication is kept in an off-limits bedroom. Per Licensee, none of the children enrolled require medication at this time. There is central air and heating in the facility. LPA did not observe any fireplaces or wall heaters in the home. Children use the restroom next to the day care room on the first floor. No cleaning products or medicines were observed in the restroom.
Per Licensee, children use the enclosed backyard for outdoor play. Per Licensee, children are supervised while playing outside. Per Licensee there are no poisons in the home. Licensee was advised that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the day care area or an area separated from other children while under adult supervision. LPA did not observe any pools or spas, or other bodies of water. Per Licensee, there are no pets in the home. LPA did not observe any pets. There is one properly stored firearm in the home.
Infant Care: Currently there are four infants enrolled in the facility. LPA observed three cribs and two play yards in the day care room. LPA observed that napping equipment does not block the entrance of the room. The following was discussed with the Licensee, infants shall not be swaddled in care, infants heads shall not be covered, there shall be no items in cribs or play yards, bumper pads shall not be used, Car seats shall not be used for sleeping.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were reviewed: Children's records contained (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227 Individual infant sleeping pla, infant 15 minute sleep logs. The facility carries day care insurance.
Staff records were reviewed: Licensee’s pediatric first aid/cpr issued by the American Heart Association expires in March 2025, Assistant’s pediatric first aid/cpr issued by the American Heart Association expires in January 2025. Licensee and assistant had proof of required immunizations on file. Assistant completed the mandated reporter training for child care providers on 3/22/23. Licensee had proof of the mandated reporter general training but not the training for child care providers. LPA attempted to assist Licensee in obtaining certificate from website. Licensee will obtain proof of training certificate.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KARIYAKARAWANA FAMILY CHILD CARE
FACILITY NUMBER: 198019361
VISIT DATE: 08/22/2023
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Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
Licensee 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.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://www.cdss.ca.gov/inforesources/child-care-licensing/ public -information-and-resources/safe-sleep as an additional resource. LPA 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. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
No deficiencies cited today.
Exit interview conducted and report was reviewed with the Licensee, Sangeetha Kariyakarawana. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
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