334845781-2-11-2020-09-CC-JHUH-BLPNKW-20200211093236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845781
Report Date: 02/11/2020
Date Signed: 02/11/2020 09:32:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KUMARAPPERUMA FAMILY CHILD CARE		FACILITY NUMBER:	334845781
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	02/11/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	07:26 AM
MET WITH:	Marian Kumarapperuma		TIME COMPLETED:	09:40 AM

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	On date and time listed, Licensing Program Analyst (LPA) arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were: The applicant, Marian Kumarapperuma, and adult son, Shalin Gunasekera. LPA toured the facility, inside and out and the following was observed and/or discussed: Normal days and hours of operation: Monday thru Friday, 6:00 AM to 6:00 PM. OFF-LIMIT AREAS INCLUDE: The complete upstairs, kitchen pantry and garage. · Appropriate fire extinguisher, and smoke detector are present and were tested by the applicant during this inspection. Fire extinguisher, and smoke detector are in working order. · A carbon monoxide detector was NOT present · All hazardous items inaccessible · Toxins locked · No guns or weapons present as of this date. Applicant understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 Regulations. · Stairs are barricaded or not applicable this is a single story home · The fireplace is properly screened · Storage of poisons is inaccessible to children and locked · Verification of control of property was obtained and on file (viewed grant deed/rental agreement) · Facility Sketch and Emergency Disaster Plan are posted · Pediatric CPR and First Aid Card - expire 12/2021 Marian Kumarapperuma · Health & Safety Certificate - completed on 12/03/2017

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KUMARAPPERUMA FAMILY CHILD CARE	FACILITY NUMBER: 334845781
	VISIT DATE: 02/11/2020

NARRATIVE

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·There are no bodies of water as of this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly covered or fenced per title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Clean, safe and age appropriate toys
· There are no toxic plants observed at this time
· Issued applicant the following: SIDS information and Shaken Baby Syndrome pamphlet – For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
· Applicant will wait until facility opens to determine IMS needs. 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
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. Resident and/or staff records reviewed on 02/11/2020 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KUMARAPPERUMA FAMILY CHILD CARE	FACILITY NUMBER: 334845781
	VISIT DATE: 02/11/2020

NARRATIVE

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The following was discussed with the applicant(s):

- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
- AB290 – Child Nutrition, effective January 1, 2016 - – In accordance with California Health and Safety Code Section 1596.866 - each family day care home licensee who provides care, shall have at least one hour of childhood nutrition training as part of the preventive health practices course or courses.
- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1597.622 (a)(1)- a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination, they must do so between August 1 and December 1 of each year.

- AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KUMARAPPERUMA FAMILY CHILD CARE	FACILITY NUMBER: 334845781
	VISIT DATE: 02/11/2020

NARRATIVE

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- AB2370 – Effective January 1, 2019 – Lead Poisoning – providers are required to provide a lead toxicity prevention handout to parents/guardians of newly enrolled and newly reenrolled children with information on risks and effects of lead poisoning; blood lead testing recommendations and requirements; and options for obtaining blood lead testing, including free and/or discounted testing. There will be a training component of this added to the Preventative Health Training beginning July 1, 2020.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

- Pre-Licensing Visit Packet provided (children’s/staff records & posting requirements included)
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file with the licensing office at all times
- Baby walkers, bouncy seats, exer-saucers and other similar items are prohibited
- The applicant is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of
30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
v Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov.
v Please subscribe at childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account. Updates can also be accessed through www.ccld.ca.gov

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KUMARAPPERUMA FAMILY CHILD CARE	FACILITY NUMBER: 334845781
	VISIT DATE: 02/11/2020

NARRATIVE

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v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

Before licensure, the following needs to be corrected/completed:

1. All electric outlets will need to have covers placed on
2. A carbon monoxide detector will need to be obtained and installed
3. All dirt holes in the back yard will need to be filled in to prevent tripping hazards
4. Final approval from the Department

An office meeting has been scheduled for Tuesday, February 25, 2020 at 2:00 p.m. in the Riverside Child Care Regional Office with Aaron Ross, Licensing Program Manager and Licensing Program Analyst, John Huynh to discuss Licensee’s responsibility and the Department’s expectations/goals.

Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn. An exit interview was conducted and a copy of this report was provided to the applicant on this date.
During the exit interview, the Applicant Marian Kumarapperuma, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.
A copy of this report was left with the Applicant and a copy must be made available upon request, to the public, for 3 years.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

LIC809 (FAS) - (06/04)

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