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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019361
Report Date: 05/22/2025
Date Signed: 05/23/2025 07:55:42 AM

Document Has Been Signed on 05/23/2025 07:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KARIYAKARAWANA FAMILY CHILD CAREFACILITY NUMBER:
198019361
ADMINISTRATOR/
DIRECTOR:		SANGEETHA KARIYAKARAWANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 256-9910
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
05/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Sangeetha KariyakarawanaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On May 22, 2025, at 11:00am Licensing Program Analysts (LPAs) A. Carter and J. Duran conducted an Unannounced Annual / Random inspection and met with licensee Sangeetha Kariyakarawana. LPAs disclosed the purpose of the inspection and was granted entry into the facility. Licensee was provided a copy of the Facility Entrance Checklist.
All adults associated to the home were found to have criminal record clearance. There were (10) daycare children present during today’s inspection and one assistant. Licensee states that there are currently (10) children enrolled. Licensee provides care to children ages ranging from 0 to 6 years of age. Licensee reports the facility’s hours of operation are Monday through Friday from 6:30am to 6:30pm. Licensee does not provide overnight care or transportation.

This is a two story home which consists of (4) bedrooms, (3) bathrooms, kitchen/dining area, living room, and attached garage. Areas accessible to children includes: downstairs bedroom (main care area), hallway bathroom, and dining room used for meals. The living room is used in passing to the main care area and dining area. Areas off limits to children and parents are: entire second floor which consists of 3 bedrooms, 2 bathrooms, kitchen and garage. LPAs observed a safety gate at the bottom and top of the stairs The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.
All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety and comfort of the children.



.....REPORT CONTINUES PAGE 1 OF 4
Denise GibbsTELEPHONE: (323) 558-2794
Andrea CarterTELEPHONE: 323-981-3350
DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KARIYAKARAWANA FAMILY CHILD CARE
FACILITY NUMBER: 198019361
VISIT DATE: 05/22/2025
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LPAs observed required posted documentation which included:
Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPAs observed completed facility records including: LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log with last drill conducted on 04/21/25.
Dual smoke/carbon monoxide detector observed and tested at facility at the time of inspection. LPAs observed the AB10BC fire extinguisher with last service date of May 9, 2025. The facility has central air and heating and maintains telephone service via cell phone.

LPAs observed age appropriate toys and learning materials available for children in care, free of loose and sharp parts. LPAs did not observe any fireplaces or wall heaters. The children use the bathroom in the hallway. LPAs did not observe hazards in the bathroom. Children nap in the main daycare area. LPAs observed napping equipment 3 cribs, 2 play yards, and mats available for children in care. Detergents, cleaning compounds, and medications are stored in an off-limits area of the home inaccessible to children in care. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. The isolation area for sick children waiting to be picked is the table in the dining area, supervised away from the other children in care. Per licensee, food is provided for children in care. LPAs reminded licensee that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.

Per licensee, the children will have access to the backyard for outside play. The play area is partially covered, providing ample shading for children in care. Per Licensee, children are supervised while playing outside. Play area is free of loose and sharp articles or objects and all trees, shrubs, and plants are maintained. LPAs did not observe any pools or bodies of water on the premises.

Infant Care: Currently licensee has 4 infants under 24 months enrolled. Each infant has their own crib/play yard observed by LPAs. Infant mattresses were observed to be firm with tightly fitted sheets. LPAs did not observe loose object, bumpers, objects hanging, or objects attached to the cribs. Napping equipment does not block entrances or exits. Licensee was advised Infants shall not be swaddled in care. Car seats shall only be used for transportation purposes and shall not be used for sleeping.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Andrea CarterTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KARIYAKARAWANA FAMILY CHILD CARE
FACILITY NUMBER: 198019361
VISIT DATE: 05/22/2025
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LPAs discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0 -24 months.

Overnight Care: There is no overnight care provided at the moment. LPAs 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 for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). All required licensing forms are in file.

Staff records were reviewed for approved Pediatric CPR / First Aid certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Pediatric CPR / First aid Card valid until: 03/01/27 and Mandated Reporter AB1207 valid until: 08/24/25.

During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.
o Licensee stated they do not have any children that needs medication administer, or any children with allergies in care at this time.
o Licensee stated that there are no smokers in the home.
o Licensee states there are no pets in the home. LPA did not observe any pets at time of inspection.
o Licensee states there is a firearm in the home. LPAs observed a properly stored firearm at time of inspection
o Licensee stated there are no bodies of water around the premises. LPA did not observe any bodies of water at time of inspection.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Andrea CarterTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KARIYAKARAWANA FAMILY CHILD CARE
FACILITY NUMBER: 198019361
VISIT DATE: 05/22/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 at https://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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Sangeetha Kariyakarawana, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Sangeetha Kariyakarawana.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Andrea CarterTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5