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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 196216501
Report Date: 12/30/2022
Date Signed: 12/30/2022 10:35:19 AM

Document Has Been Signed on 12/30/2022 10:35 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:WALAWEDURAGE FAMILY CHILD CAREFACILITY NUMBER:
196216501
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
12/30/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nayani WalawedurageTIME COMPLETED:
10:50 AM
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This is a change of location, previous facility number: 196216235

On December 30, 2022 at 9:30 AM, Licensing Program Analyst (LPA) Susana Martinez conducted an announced pre-licensing inspection. LPA met with licensee Nayani Walaweurage and advised her of the purpose for the inspection. Prior to entering the home, LPA conducted COVID-19 screening questions, all answers indicated no risks present. Together with the licensee, LPA toured the home inside and outside. At the time of the inspection there were 2 children present which were licensee's own children.

The facility is a two-story home with four (4) bedrooms and three (3) bathrooms. The licensee plans on using the living room, dining room, kitchen, downstairs bathroom, and backyard for day-care. The required documents that should be posted were observed to be mounted on the wall at the entrance of the home. LPA observed a secure gate at the bottom of the stairs preventing any children from accessing the second floor. Licensee states there are no guns or ammunition in the home. During the inspection LPA observed sufficient age-appropriate toys and learning materials readily accessible to children. No toxins/hazardous items were observed during today's visit. No bodies of water were present at the time of inspection.

Licensee states she will be providing snacks and meals to children in care. The kitchen was observed to be clean and free of hazardous items. LPA observed safety locks on the kitchen cabinets preventing children from opening them. Licensee states cleaning supplies, disinfectants, etc are located under the sink which also has a safety lock. A regulatory fire extinguisher was observed to be mounted in the kitchen near the smoke/carbon monoxide detector. Licensee was reminded to service or purchase the fire extinguisher yearly.

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SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: WALAWEDURAGE FAMILY CHILD CARE
FACILITY NUMBER: 196216501
VISIT DATE: 12/30/2022
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Licensee's Pediatric First Aid/CPR certificate is valid through 7/24/2023. Licensee was reminded to renew her certification every two years. Licensee's mandated reported certification was observed to be valid through 3/19/2023. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 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 [applicant, licensee, or facility representative] 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.

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SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2022
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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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: WALAWEDURAGE FAMILY CHILD CARE
FACILITY NUMBER: 196216501
VISIT DATE: 12/30/2022
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The home meets Title 22 Division 12 requirements of a Small FCCH. Effective date of license is today, December 30, 2022.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Nayani Walaweurage.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2022
LIC809 (FAS) - (06/04)
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