198016370-9-20-2023-54-CC-AMOY-CVV8ZU-20230920225808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016370
Report Date: 09/19/2023
Date Signed: 09/20/2023 11:01:36 PM

Document Has Been Signed on 09/20/2023 11:01 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	WETTEWA FAMILY CHILD CARE		FACILITY NUMBER:	198016370
ADMINISTRATOR:	WETTEWA,BALASURIYA SUKETHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 213-5655
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90715
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 9	DATE:	09/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Balasuriya Wettewa, Licensee		TIME COMPLETED:	01:30 PM

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Licensing Program Analysts (LPAs) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival LPAs met with Balasuriya Wettewa, Licensee who guided analyst on a tour of the facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. During this inspection, there were nine children present including three infants. Also present was Don Sriyane Dararmapalge, Assistant. The licensee states that she currently has ten (10) children enrolled. A children’s roster was available. Individuals residing in the home were discussed and noted. All individuals present in the home have obtained a criminal record clearance or exemption.

All areas identified on the facility sketch were inspected. This is a one-story home which consists of three bedrooms, two bathrooms, kitchen, living room, dining room, den (daycare room), garage, and backyard (fenced).

Per Licensee, the areas used by children include: Den (daycare room), one bathroom (located in hallway), and backyard (fenced). Areas used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating.
Per Licensee, the area off limits to children and parents include: three bedrooms, one bathroom, kitchen, dining room, living room, and garage. Rooms that are off-limits need to be made inaccessible during operating hours.

Per licensee, the children are supervised when they walk through the dining room, living room by kitchen to the bathroom located in hallway by bedrooms.

The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA Mooberry observed that cleaning solutions and items are stored in overhead cabinet in the den area inaccessible to children.
Page 1 Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WETTEWA FAMILY CHILD CARE	FACILITY NUMBER: 198016370
	VISIT DATE: 09/19/2023

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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 12/8/22, Licensee was reminded that fire extinguisher needs to be serviced yearly. LPAs confirmed phone number and email address.

The home is observed to be clean and orderly. There are toys and other age-appropriate material available.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home.

Children are using the backyard for outdoor play. The outdoor play area was observed to be fenced with age appropriate toys. There is an toddler swing set anchored to the ground. LPA did not observe any objects that could be hazardous to children in care. The facility does not have a pool or similar bodies of water, there are no pets in the home.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)
Two out of six children's records did not have immunization records.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee and assistant did not have current CPR/1st Aid on file.

There are four (4) infants under age two in care. LPA Sanchez provided PIN 20-24-CCP, LIC 9227, sample sleep log and 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 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.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WETTEWA FAMILY CHILD CARE	FACILITY NUMBER: 198016370
	VISIT DATE: 09/19/2023

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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/

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Licensee 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.

The following deficiencies will be cited today in accordance with California Code of Regulations Title 22, Division 12 Chapter 1.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Balasuriya Wettewa

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/20/2023 11:01 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 09/19/2023 at 12:45 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WETTEWA FAMILY CHILD CARE	FACILITY NUMBER: 198016370
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

(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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that 2 out of two staff present did not have the required Pediatric CPR/1st Aid which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/05/2023
	Plan of Correction
1 2 3 4	Per licensee, proof of correction will be sent LPA via email by POC due date

Type B

Section Cited

CCR

102418(g)

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 6 children's records reviewed did not have immunization record on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/05/2023
	Plan of Correction
1 2 3 4	Per licensee, proof of correction will be sent to LPA via email by POC due date

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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