198020049-9-16-2021-54-CC-KCHE-C6WRU6-20210916131926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020049
Report Date: 09/16/2021
Date Signed: 09/16/2021 01:19:43 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HEWA RAHINDUWAGE FAMILY CHILD CARE		FACILITY NUMBER:	198020049
ADMINISTRATOR:	DINESHA HEWARAHINDUWAGE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 387-6737
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90715
CAPACITY:	14	CENSUS: 10	DATE:	09/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Dinesha Hewarahindu, Licensee		TIME COMPLETED:	02:00 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	Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 09/16/2021 at 10:40 AM. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Dinesha, Hewarahindu, who guided the LPA on a tour of the facility. Also present was Licensee's Assistant, who has criminal record clearance. There are four people living in the home and all adults have criminal record clearance. There were ten day care children (four infants) present during today’s inspection. Licensee states that there are currently twelve children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 7am to 6pm, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on August 2021. This is a single story home which consists of three bedrooms and two bathrooms, kitchen, living room, and den. At 10:51 AM, LPA observed there is a fireplace in the home that is barricaded by a gate. Areas used by the children include the living room, one restroom, and den(day care space). Per Licensee, areas off limits to children and parents include all three bedrooms, Bathroom 2 (located inside a bedroom), and kitchen. At 10:47 AM, LPA observed that there is an operable baby gate blocking hallway to all three bedrooms and the entrance to kitchen making these areas off limits to children in care at time of inspection. 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 of the children. Living room is located upon entry of the home where LPA observed two couches, tall table and chairs, and two pack-n-plays (Cosco & Graco brand). At 10:46 AM, LPA observed infant sleeping in pack-n-play and observed infant safe sleep regulations being met at time of inspection. There is a working telephone maintained in the home. At 10:50 AM, LPA observed den, which will be main day care space, located to the rear of the home. LPA observed large plastic legos, soft foam Report continues- Page 1 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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

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: 09/16/2021

NARRATIVE

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blocks, doll houses, play kitchens, and age appropriate toys, free of loose and sharp parts available for children at time of inspection. At 10:52 AM, LPA observed Bathroom 1, used by the children located to the left of day care space, to have adequate hand washing supplies and to be free of hazards at time of inspection. At 10:53 AM, LPA observed diaper changing table right outside Bathroom 1 and two more Graco pack-n-plays in hallway leading to Bathroom 1. Per licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 10:57 AM, LPA observed these items to be kept in high shelves in off limits kitchen. The Licensee does understand that poison must be locked with a key or combination lock.

Per licensee, the children will have access to backyard area through glass sliding glass door in day care space. At 11:00 AM, LPA observed backyard has turf grass and adequate perimeter fencing through-out the yard, per Licensee the left side of yard is off limits and LPA observed an operable baby gate that is bolted to the house making area off limits to children in care at time of inspection. LPA observed small plastic slides, plastic play house, plastic ride along toy, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any of these items. Per Licensee, they provide food for children in care. Licensee states sick policy has been updated, sick isolation area will be Living Room where children will wait to be picked up.

At 10:57 AM, LPA observed the valve on the required 2A 10BC fire extinguisher leaning close to red space and does not have service tag at time of inspection, this poses a potential health and safety risk to children in care. Smoke and carbon monoxide detectors are in operable condition. Per Licensee, First Aid kit is kept in upper cabinet in the hallway, LPA observed First Aid kit and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 03/27/2023
—Mandated Reporter AB1207 Completed: 06/15/2021
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Report continues- Page 2 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: 09/16/2021

NARRATIVE

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The following were discussed:
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. A hard copy of PIN 21-15-CCLD Kiddie Truesense Smoke & Combination Smoke/Carbon Monoxide Alarms Recall, PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effectwere given to provider.

Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during inspection.
Report Continues- Page 3 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HEWA RAHINDUWAGE FAMILY CHILD CARE	FACILITY NUMBER: 198020049
	VISIT DATE: 09/16/2021

NARRATIVE

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Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Dinesha Hewarahindu.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HEWA RAHINDUWAGE FAMILY CHILD CARE	FACILITY NUMBER: 198020049
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (1) Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the Licensee did not comply with the section cited above by not having the fire extinguisher serviced annually, Licensee stated last serviced in 2019. LPA did not observe a service tag on fire extinguisher and arrow leaning towards red at time of inspection; this poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/23/2021
	Plan of Correction
1 2 3 4	Licensee states they will provide a photo of service tag to LPA by POC date via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC809 (FAS) - (06/04)

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