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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415431
Report Date: 08/14/2024
Date Signed: 08/14/2024 03:02:39 PM

Document Has Been Signed on 08/14/2024 03:02 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:NILANDUWA FAMILY CHILD CAREFACILITY NUMBER:
197415431
ADMINISTRATOR/
DIRECTOR:		NILANDUWA, SUCHITRA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 940-9235
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Licensee Suchitra NilanduwaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 8/14/2024, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observed 11 children in care and the Licensee and the Assistant providing care and supervision.

The operational childcare hours are Monday through Friday, 6:00am to 6:00pm, ages 0 months to 10 years old.

This is a two-story family home. There is a living room, kitchen, six bedrooms, four bathrooms, patio, laundry area, and attached garage and is accessible from inside the home. The stairs leading to the off-limits area is properly barricaded with a baby gate as there are children under the age of 5 in care. Licensee does provide napping, there is one play pen and 15 cots. The off-limits areas are two upstairs bedrooms, two upstairs bathrooms, laundry area, and garage; the garage door is not made physically inaccessible and can be opened from inside of the home, technical assistance was provided to ensure the Licensee makes the garage door physically off-limits. Licensee provides breakfast, lunch, and snacks to the children in care, the Licensee is aware to properly label and refrigerate any meals brought from home. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Outlets: the outlet covers were all properly covered in the on-limits areas. Hanging window blind cords: there are no hanging cords. The Licensee has installed a single action door handle that allows children to safely exit in emergencies. The manual fire alarm is electric in a system and attached to the wall and can be triggered manually. Pets: there is one dog on premises, the Licensee attests the dog is fully vaccinated and is aware they must keep those records on file. Phone service: There is a working landline and cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does not provide transportation for children. Isolation occurs in the on-limit second bedroom near a
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NILANDUWA FAMILY CHILD CARE
FACILITY NUMBER: 197415431
VISIT DATE: 08/14/2024
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bathroom for children in care showing signs of illness. The calming area is located in the patio area. There is a fireplace that is screened and inaccessible to children in care, Licensee attests they do not use their fireplace.

The facility fees are currently past due of $210.00, Licensee was made aware the not paying the facility fees can cause the closure of the facility; Licensee states she understands and plans to pay them today.

Knives will be kept in the kitchen in a closet secured by a safety lock to make it inaccessible to children in care. Medication will be kept in the kitchen in a closet secured by a safety lock to make it inaccessible to children in care. Cleaning supplies and chemicals will be kept in the laundry room to make them inaccessible to children in care. Medication, knives, & cleaning supplies were accessible to children during the visit, this is a Type A violation, see the LIC 809D for details.
There are age-appropriate toys and equipment on the premises. There is a back yard and two side yards; the side yard on the left is gated with a lock and the side yard on the right has large equipment and tools that pose a security risk to the children in care, this is a violation, see the LIC 809 for the details. The back yard area is free from sharp objects, broken toys/furniture, and other debris. The back yard has a climbing structure that has proper cushioning material underneath and around the perimeter of the structure which is grass. There was a tricycle that was missing handle bars covers exposing the metal underneath, the Licensee placed the tricycle in an off-limits, gated and locked side yard immediately. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons, firearms, or ammunition. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauze, adhesive tape, guide, and cleansing pads/solution was observed to be complete and inaccessible to children kept high in the patio area. The required fire extinguisher (3A40BC) is reading in green, has not been tested annually per fire clearance, this is a violation. Smoke and carbon monoxide detectors were found to be in operating condition, tested at 9:54am and 9:46am, respectively. Fire and Disaster drills are conducted at least every six-months, last drills were recorded on 6/23/2024 at 11:00am.
Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), PUB 269 Child Passenger Safety Law, and missing the Earthquake Preparedness Checklist (LIC 9148), LPA provided the form and the Licensee immediately posted it.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NILANDUWA FAMILY CHILD CARE
FACILITY NUMBER: 197415431
VISIT DATE: 08/14/2024
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Licensee has insurance coverage for the facility from Makel Insurance, expiring in 12/2024.

Licensee completed the LIC 855 Declaration to ensure that the day care children will not have access to the indoor aquarium in the living room.

The Licensee did not provide proof of immunization against pertussis (TDAP), measles (MMR), and Influenza vaccination for self, there is a TB clearance; the Licensee did have proof of TB clearance for their spouse. Licensee was not able to provide a valid Pediatric CPR/First Aid training for herself and staff, this is a Type B violation, see the LIC 809D for the details. Child Care Provider Mandated Reporter Training Certificate has been completed for the Licensee and Staff 2; Staff 1 needs to update their training as it has expired. Licensee staff personnel records included the following: the LIC 9108-Statement Acknowledging the Requirement to Report Child Abuse, the LIC 9052- Employee Rights, and background clearances; Staff 1 is missing the MMR, Flu, and CPR and Staff 2 is missing the TB, Flu, and CPR.



Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, and PM 286-California School Immunization Record; there are no school age enrolled children but the Licensee is aware that they need the school enrollment documents for any school age children.

Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NILANDUWA FAMILY CHILD CARE
FACILITY NUMBER: 197415431
VISIT DATE: 08/14/2024
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The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed the 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.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website 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: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NILANDUWA FAMILY CHILD CARE
FACILITY NUMBER: 197415431
VISIT DATE: 08/14/2024
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During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and the RSO profile is completed in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates, please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & call at (916) 654-1541.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is not in compliance, one Type A and two Type B Deficiencies have been cited. Please, see the LIC 809D for the citations. As a Type A deficiency has been cited, a copy of the citation and licensing report must be posted for 30 days. The same report must be provided to Parents/Guardians and the Acknowledgment of Receipt of Licensing Reports LIC 9224 must be signed by Parents/Guardians of all enrolled children and any newly enrolled children in the next 12 months following the citation. If these requirements are not met, civil penalties per violation will be assessed.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Licensee.

All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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Document Has Been Signed on 08/14/2024 03:02 PM - It Cannot Be Edited


Created By: Andrea Pittman On 08/14/2024 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NILANDUWA FAMILY CHILD CARE
FACILITY NUMBER: 197415431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation)and (interview), the licensee did not comply with the section cited above having cleaning supplies accessible in kitchen and bathroom, medication and sharps in the kitchen, fire clearance fire extinguisher not being checked annually, and having heavy tools and equipment accessible in the side yard which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2024
Plan of Correction
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Licensee made the cleaning supplies and toiletries inaccessible in the bathroom during the visit; the cleaning supplies in the kitchen inaccessible during the visit; and the medication and sharps inaccessible in the kitchen. The Licensee will send via text/email picture of the side yard being made inaccessible and the fire extinguisher being serviced no later than 8/15/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


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Document Has Been Signed on 08/14/2024 03:02 PM - It Cannot Be Edited


Created By: Andrea Pittman On 08/14/2024 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NILANDUWA FAMILY CHILD CARE
FACILITY NUMBER: 197415431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having proof of vaccination/immunization for the Licensee: MMR, Tdap, & Flu; for Staff 1: MMR & Flu; and Staff 2: TB and Flu which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2024
Plan of Correction
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Licensee will e-mail or text the proof of immunization/vaccination for the Licensee, Staff 1, and Staff 2 no later than 9/11/2024.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having the Licensee, Staff 1, and Staff 2 complete the correct Pediatric First Aid/CPR training prior to expiration of the certification which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/28/2024
Plan of Correction
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Licensee will e-mail or text proof of completion of the training no later than 8/28/2024 for all the staff.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


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