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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410494
Report Date: 10/21/2024
Date Signed: 10/21/2024 10:08:55 AM

Document Has Been Signed on 10/21/2024 10:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:JAYASINGHE, PRIYANTHIFACILITY NUMBER:
434410494
ADMINISTRATOR/
DIRECTOR:		JAYASINGHE, PRIYANTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 245-6026
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/21/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Priyanthi JayasingheTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Priyanthi Jayasinghe, Licensee, for an announced case management inspection. Licensee has requested to activate her license from "inactive" status. LPA was granted access to the home by the Licensee. There were no other adults or children present in the home during today's inspection. LPA observed the required postings, including the facility license, near the front entrance to the day care. Days and hours of operation are Monday - Friday from 9:00 AM to 5:30 PM. Licensee and one adult son are the adults residing in the home. There are no minor children residing in the home.

Licensee states that she does not have liability insurance for the day care and will issue the Affidavit Regarding Liability Insurance For Family Child Care Home (LIC 282). Licensee has current CPR and First Aid certifications on file. Licensee has the required vaccines (MMR, Tdap, & flu) and are current with the Mandated Reporter Training for Child Care Workers. No staff or child(ren) files were reviewed during today's inspection since the Licensee has no employee(s) or child(ren) enrolled at this time.

LPA toured the indoor and outdoor areas of the home with the Licensee during today's inspection. Licensee has a working telephone in the home. The home is clean, orderly, (including heating/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. The main day care areas in the home will be the living room, day care room, and one bathroom. Licensee states that the entrance to the day care is via the right side gate. There are no wall heater/open face heater units or stairs 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. Off limit areas outside the home: one locked storage shed.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee states that she does not have any weapons in the home. Licensee has one dog in the home which will be kept the off limit areas of the home during day care hours. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to children.

Licensee states that parents will provide all meals for the day care children. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee states that nobody smokes and they understand that smoking is prohibited in the home.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JAYASINGHE, PRIYANTHI
FACILITY NUMBER: 434410494
VISIT DATE: 10/21/2024
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Licensee does not administer medication to children. 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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours (80% of operating hours) and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the home without at least two qualified adults present. Licensee understands that she must comply with the capacity/ratio requirements of the small license whenever there is only one qualified adult present in the home. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that she does not transport any day care children. 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.

Priyanthi Jayasinghe, Licensee, 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.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Exit interview conducted and report was reviewed with the Licensee, Priyanthi Jayasinghe. No deficiencies issued during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
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