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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845781
Report Date: 02/27/2020
Date Signed: 02/27/2020 08:50:49 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 CAREFACILITY NUMBER:
334845781
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
02/27/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:MARIAN KUMARAPPERUMATIME COMPLETED:
09:00 AM
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On date and time listed, Licensing Program Manager (LPM) Aaron Ross and Licensing Program Analyst (LPA) John Huynh conducted a meeting held in the Riverside Child Care Regional Office and met with Applicant, Marian Kumarapperuma. The conference focused on the following items:

1. Applicant's Responsibility and Department's Expectations/Goals.
2. Personal Rights
3. Supervision
4. Review Child Care Provider videos at: https://ccld.childcarevideos.org/family-child-care-providers
5. When needed, communicate with Child Care Advocates and RCOE/Resource and Referrals groups regarding additional training.
6. Applicant understands she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.The intent of this 20 percent provision is to ensure that the licensee is the primary caregiver and does not delegate this to someone else on a regular basis.
7. Information was provided regarding the Quarterly Stakeholders Meeting for a Family Child Care Homes on Tuesday, March 24, 2020.
8. Applicant understands the requirement of submitting an Unusual Incident Report when necessary.

Applicant Marian Kumarapperuma understood and agreed.

An exit interview was conducted, and a copy of this report was provided to the Applicant.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John HuynhTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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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