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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410494
Report Date: 08/04/2021
Date Signed: 08/04/2021 01:46:53 PM

Document Has Been Signed on 08/04/2021 01:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:JAYASINGHE, PRIYANTHIFACILITY NUMBER:
434410494
ADMINISTRATOR:JAYASINGHE, PRIYANTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 245-6026
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Priyanthi JayasingheTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Priyanthi Jayasinghe, Licensee, for unannounced Required – 1 year annual inspection (KIT 2). LPA was granted access to the home by the Licensee. There were no day care children present in the home. The Licensee states that she has not had any children in the day care since mid March 2020. LPA observed the required postings, including the facility license, in the home. Days and hours of operation are Monday - Friday from 8:45 AM to 5:30 PM. The adults that reside in the home are the Licensee and one adult son.

LPA reviewed a current Child Care Facility Roster during today's inspection. The Licensee has not conducted any fire/disaster drills since she has not had any day care children since mid March 2020. The Licensee has the required vaccine records (MMR, Tdap, & flu - opt out) and current Mandated Reporter Training for Child Care Workers certificate. The Licensee's CPR and First Aid certifications are current. Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Off limit areas in the home: three bedrooms, one bathroom, one furnace closet, one barricaded fireplace (located in the living room), kitchen, dining room, and attached garage. There are no stairs inside the home. Off limit areas outside the home: one locked storage shed.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 08/04/2021):
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JAYASINGHE, PRIYANTHI
FACILITY NUMBER: 434410494
VISIT DATE: 08/04/2021
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/04/2021):

LPA observed a fully charged 3A40BC fire extinguisher, working smoke & carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are inaccessible to children and stored in the locked storage shed, located in the backyard. The Licensee states that she does not administer any medication to the day care children.

A review of staff records on August 2, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with a qualified assistant present. The Licensee also understands that she must comply with the capacity and ratio requirements of the small Family Child Care Home license whenever there is only one qualified adult present in the day care. The Licensee states that she does not transport day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA conducted an exit interview with the Licensee and advised her that no deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
LIC809 (FAS) - (06/04)
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