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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313717
Report Date: 03/29/2021
Date Signed: 03/29/2021 03:23:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ABEYSEKERA, UDENIFACILITY NUMBER:
304313717
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
03/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Udeni AbeysekeraTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted a case management inspection, in response to licensee’s request for a capacity increase. LPA met with licensee Udeni Abeysekera, who guided analyst on a tour of the facility. Also present during today’s inspection was licensee’s husband and son. LPA Torrence observed seven napping children in the designated daycare area. The facility was within licensed capacity and the required ratio. Licensee stated there are currently three adults and no minor children living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility is a two-story home with four bedrooms, 2.5 bathrooms, living room, family room, kitchen, dining room, front yard, fenced backyard, attached garage, and a small storage closet. Licensee has designated the family room, half bathroom, and fenced backyard as part of her day-care. Licensee has designated entire second floor, living room, dining room, kitchen, front yard, small storage closet, and attached garage as the off-limit areas. Licensee has placed a safety gate at the bottom of the stairs leading to the second floor. The kitchen has two entrances; therefore, licensee has placed a safety gate at one entrance and has lined up children’s cubby shelves at the other entrance. Licensee has also placed a safety gate between the family room (daycare room) and living room. These safety gates are placed, to ensure the off-limit areas are inaccessible to the children in care. The licensee acknowledged the children may never enter the off-limit areas, during operation hours. Control of property was verified by LPA during today’s inspection. The licensee has a landline and cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. Licensee was informed and understands the home is to be free from smoking during hours of operation.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ABEYSEKERA, UDENI
FACILITY NUMBER: 304313717
VISIT DATE: 03/29/2021
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The facility does have a fireplace; barricaded by a locked glass door and shelves. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible by means of a safety gate and children’s cubby shelves. Poisons/Hazardous items are not stored on site, and none were observed. There are no bodies of water. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. The licensee stated there are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.

Per licensee, she does not provide food for the children. Per licensee, food and water bottles are brought from home. However, if children forget their water bottles, licensee will provide them with one. LPA reminded licensee, that if food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.



EMSA approved Pediatric CPR and Pediatric First Aide are current for the licensee and assistant, expires 08/2021 and 07/2022 respectively.

LPA advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.



During todays’ inspection, there were no deficiency cited and licensee was in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ABEYSEKERA, UDENI
FACILITY NUMBER: 304313717
VISIT DATE: 03/29/2021
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An exit interview was conducted. The report was reviewed and discussed with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. The Notice of Site Visit must be posted on or adjacent to the door. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

End of Report

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
LIC809 (FAS) - (06/04)
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