198019374-8-19-2021-33-CC-BBEL-C62T49-20210819142335

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019374
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:24:08 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:	JAYASEKARA FAMILY CHILD CARE		FACILITY NUMBER:	198019374
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Licensee Nimali Jayasekara		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	An unannounced, in-person Annual/Required-1 year (Case Management-Licensee-initiated) inspection was conducted on this date by Licensing Program Analyst (LPA) Emiko Bell. The purpose of the inspection is because Licensee is requesting an increase in capacity from a small (capacity 8) to a large (capacity 14) and because the Department is now conducting annual inspections. Licensee qualifies because she has been licensed at this residence since 05/05/17. Upon arrival, LPA was greeted and let into the residence by Licensee Jayasekara, to whom the reason for the inspection was announced. Throughout the inspection, licensee, her assistant, and LPA all took precautionary measures against COVID-19 by wearing face coverings and maintaining social distancing. Licensee's spouse was in the bedroom and licensee's mother, who is licensee's assistant, were also present the duration of the inspection. All adults have Criminal Background Clearance and are associated to the facility. At 09:30, Licensee began guiding LPA on a tour of the premises. Census: Staff-child ratio was met. (See 811 for details.) Licensee's days and hours of operation are Monday-Friday, 07:30 A.M. to 06:00 P.M. This is a single-story, single family residence with three bedrooms and two bathrooms. All areas identified on the facility sketches were inspected in the following order: (indoors): the hallway bathroom, the dining room, the living room, and the play area and then (outdoors): the backyard. The

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JAYASEKARA FAMILY CHILD CARE	FACILITY NUMBER: 198019374
	VISIT DATE: 08/19/2021

NARRATIVE

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areas designated as off-limits were not inspected: (indoors): the three bedrooms (including the bathroom in the master bedroom) and the garage. Though the kitchen is designated off-limits, as
it was not rendered inaccessible on one side, LPA inspected the kitchen.

Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (licensee has a landline and a cell phone), heating and ventilation (there is central heating and air-conditioning and in the dining room, a ceiling fan), inaccessibility to poisons, detergents (they are kept in the garage), cleaning compounds (they are kept under the kitchen sink),
medicine and other hazardous items that can pose a danger to children.

Toys and napping equipment: There are age-appropriate toys and napping equipment on the premises. LPA observed one cot, one big mattress and four play yards on/in which the children nap. Licensee stated that she will ask the parents to provide mats/cots or will purchase more when the capacity increase is granted.

Parent Board: The Parent Board is on a wall of the play room directly next to the entryway. LPA observed the Notification of Parents Rights, the Emergency Disaster Plan and the license posted. COVID-19 posters are posted both outdoors and indoors by the front door.

Fire safety: There are three combination smoke/carbon monoxide detectors on the premises: one in the hallway leading to the bedrooms and the bathroom; one in the bathroom; and one in the play room; all were tested and are operable. The fire extinguisher is mounted in the kitchen; it was last serviced 05/11/21. It is size 2-A:10-B:C.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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: JAYASEKARA FAMILY CHILD CARE	FACILITY NUMBER: 198019374
	VISIT DATE: 08/19/2021

NARRATIVE

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Transportation: Licensee stated that at this time, she does not provide transportation.

Firearms: Licensee stated that there are currently no weapons or firearms on the premises.

Incidental Medical Services: 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

There are two First Aid Kits, both of which are kept in the kitchen.

Backyard: The backyard is completely fenced by a brick wall. Licensee has a rug underneath the small play equipment on the covered patio.

Paperwork: Licensee's roster was current and complete. Licensee completed the Lead Poisoning Prevention for Child Care Providers on 08/05/21. Licensee and her assistant's Pediatric First Aid/CPR cards were issued by the American Heart Association and expire 10/22. Licensee completed Mandated Reporter Training on 08/09/20. Licensee and her assistant have been immunized against influenza, pertussis, and measles Of two staff files reviewed, both were complete.

As there are five children enrolled, all five files were reviewed for the required forms. Though licensee is documenting the 15-minute checks for infants, as she thought that the

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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: JAYASEKARA FAMILY CHILD CARE	FACILITY NUMBER: 198019374
	VISIT DATE: 08/19/2021

NARRATIVE

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checks stop once the child reaches 12 months (one year) old, the files of children #3 and #5 were missing the 15 minute checks, which licensee documents on an "Infant Sleep Chart." Of five files reviewed, three were complete and two were missing one document. A Technical Violation has been issued for this and licensee was advised to begin maintaining documentation on the two infants effective today.

The residence appears to be iin compliance and to meet Title 22 regulations.

The capacity increase will be granted effective 08/19/21.

********During today's visit, the Confidential Names list was provided to the Licensee.*****

The Notice of Site Visit was posted by Licensee in LPA's presence. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.

An exit interview has been conducted with and a copy of this report has been signed by and provided to Licensee Namali Jayasekara. Appeal Rights were providedto and explained to Licensee as well.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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