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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700851
Report Date: 07/19/2024
Date Signed: 07/19/2024 11:07:10 AM

Document Has Been Signed on 07/19/2024 11:07 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:NISSANKA FAMILY CHILD CAREFACILITY NUMBER:
197700851
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/19/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Darshana Nissanka, ApplicantTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On July 19, 2024, Licensing Program Analysts (LPA) Annelise Villa conducted a pre-licensing inspection with Applicant Darshana Nissanka, who guided LPA on a tour of the facility. This is a two-story house with 3 bedrooms, and 2.5 bathrooms, living room, family room, dining room, garage, laundry, kitchen, and front and back yards. The adults residing in the home are applicant.

The facility will operate 24 hours a day, Monday through Sunday with a license capacity of 8 children. LPA went over the childcare ratios for a small family home with applicant and provided applicant a copy.

Main care will be provided in family room and living room. Children will eat at children’s tables set up in the family room and dining room. The day care children will utilize bathroom #1 located on the left side of the home. Off limit areas will be all upstairs areas including bedrooms #1-3, bathroom #2-3, kitchen, garage, and front yard.

LPA observed day care area to be clean and orderly, central air and heating, age-appropriate toys and play equipment, working smoke and carbon monoxide detectors are in operable condition.

Children’s restroom is located on the left side of the home in the hallway. Bathroom #1 was observed to be free of hazardous materials or objects. LPA reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPA observed a clean, safe and operable toilet and faucet.


Continued on LIC 809-C
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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 4
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: NISSANKA FAMILY CHILD CARE
FACILITY NUMBER: 197700851
VISIT DATE: 07/19/2024
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LPA observed a fully charge 2A10BC fire extinguisher in the family room and first aid kit during the inspection located in daycare area. Per applicant, the medications are located in an inaccessible area of the home. Cleaning items are inaccessible to children stored in the laundry room which is inaccessible to children in care.

Kitchen: The kitchen will be off limits to children in care. The kitchen was observed to be clean and orderly. The following are inaccessible: Sharp items are stored above the fridge and off limits to children in care. LPA observed the refrigerator and freezer to be clean and fully stocked. LPA discussed with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent. Applicant is interested in a food program.

Outdoor: Children will use the back yard for outdoor play. The front yard is off limits to children in care. LPA observed the back yard to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. Applicant is advised all outdoor play shall be supervised at all times. Gardening tools were observed to be in a locked shed on the side of the house. There are no bodies of water on the premises.

Pools, Spas, or Bodies of Water: There are no pools, spas, or bodies of water.

Applicant 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.

Documents Provided and or Discussed: The following were provided to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC 9227), water lead poster, required postings and list of CCLD forms required for child file each child in care (LIC 311D). Applicant stated currently does not have childcare insurance but plans to. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Continued on LIC 809-C
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: NISSANKA FAMILY CHILD CARE
FACILITY NUMBER: 197700851
VISIT DATE: 07/19/2024
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Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident to the department. Applicant was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

Advisory/Other: Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Electrical outlets are inaccessible to children. Applicant is aware no infant shall be swaddled, and car seat shall not be used for sleeping. Applicant is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the infant’s status. Applicant should refer to regulation 102425(J) for documentation requirement. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping. LPA discussed the safe sleep regulations with applicant, including Safe Sleep PIN 20-24-CCP 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 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.

Applicant was informed smoking is prohibited. Applicant further stated no one smokes in the home. LPA discussed Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicant with a visual copy of prohibited items. LPA did not observe prohibited items during the inspection. Per applicant no firearms are present in the home. Applicant was informed her cell phone shall be available and always charged during daycare hours.

Continued on LIC 809-C
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: NISSANKA FAMILY CHILD CARE
FACILITY NUMBER: 197700851
VISIT DATE: 07/19/2024
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Incidental Medical Services (IMS) policy was discussed, informing applicant when any IMS is provided, a plan for providing IMS must be submitted to the Department prior to providing care to a child that need IMS. The plan shall state the type of IMS the facility will be offering, stating the person providing care has been trained to provide the named IMS. The plan will also provide the steps that will be taken when IMS is provided to a child.

The following information regarding ADA was discuss and the following information 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

Licensee 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.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

As a result of this inspection, it is determined this home is in compliance with Title 22 regulations and ready for licensure.



Exit interview conducted copy of this report was provided to applicant along with notice of site visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4