198020049-6-6-2019-54-CC-JHUA-BCVQ7H-20190606115509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020049
Report Date: 06/06/2019
Date Signed: 06/06/2019 11:55:13 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:	HEWA RAHINDUWAGE FAMILY CHILD CARE		FACILITY NUMBER:	198020049
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	06/06/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Hewa Rahinduwage		TIME COMPLETED:	12:00 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	Case management inspection for capacity increase conducted by Licensing Program Analyst, (LPA) Jennifer Hua. LPA met with licensee, who guided LPA on a facility tour. The facility is a single-story home with 3 bedrooms and 2 bathrooms. Per Licensee, total 2 adults and 2 minors reside in the home. Child care areas for children were inspected as follows: Back room (enclosed patio/day care room), bathroom in day care room and fenced back yard. Play yards are set up in the living room for napping babies only. Per licensee, there are no weapons, firearms, swimming pool or spa or bodies of water on the premises. There are age appropriate toys and equipment on the premises. The smoke/carbon monoxide detectors and fire extinguisher (2A 10BC) are in operable condition. Areas off limits include: The rest of the home. There are safety gates in place. Front yard and garage. -Licensee is current in Pediatric First Aid/CPR. Certificate will expire on 12/2/19. -Child Care Roster, Disaster Plan, Children records and required licensing forms were reviewed/discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement. Licensee completed her Mandated Reporter Training on 2/25/18 as noted on certificate. Licensee was informed that certificate shall be renewed every 2 years.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

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: HEWA RAHINDUWAGE FAMILY CHILD CARE	FACILITY NUMBER: 198020049
	VISIT DATE: 06/06/2019

NARRATIVE

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The following was discussed: Individuals who are 18 years of age or older living/working in the home must be finger print cleared prior to being on the premise. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil penalty for uncleared adult is an immediate $100 per day Civil Penalty, for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the Department a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.
Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, Johnny jumpers, exersaucers, bouncers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby. A child Care Provider Guide Regarding Safe Sleep was provided and explained. Drills conducted on 5/17/19. Affidavit regarding liability insurance form in children files.
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) 514-0388 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
· Dog(s) and or pets should be isolated from children in care. No pets
· It is recommended that a First Aid kit be available on premises.
Outdoor supervision required at all times.

Fire clearance has been approved. Increase is approved.
Exit interview was conducted with licensee. No deficiency cited.
Site visit notice posted. Licensee advised to keep notice posted for 30 days or a civil penalty $100 will be assessed.
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

LIC809 (FAS) - (06/04)

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