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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019180
Report Date: 11/07/2024
Date Signed: 11/07/2024 05:15:00 PM

Document Has Been Signed on 11/07/2024 05:15 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SUBASINGHE FAMILY CHILD CAREFACILITY NUMBER:
198019180
ADMINISTRATOR/
DIRECTOR:		KALYANI SUBASINGHEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 316-6185
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/07/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Licensee, Kalyani SubasingheTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 11/05/2024 at 9:40am, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced annual continuation inspection at the facility noted above and met with assistant 1 (A1) and assistant 2 (A2). LPA disclosed the purpose of today's visit and requested a tour of the facility. A2 guided LPA on a tour. The operating hours are Monday through Friday 6am to 5pm. Individuals residing at the home were discussed and noted. Present during the visit were 2 assistants, adult 1 and 5 children. All adults providing care to children during visit were fingerprint cleared.

At approximately 10: 15am, licensee arrived at the facility.

This inspection report is based on observations and findings from an inspection conducted on 10/29/2024. On that day, the file review and inspection report were not completed in full due to time limitations. The information contained herein may not reflect the current condition of the home at the time of this report’s issuance.

Areas accessible to children include 1 bathroom, living room, dining room, kitchen (through passing), and fenced backyard. Per licensee, the children utilize the fenced backyard for outdoor activity. Areas that are inaccessible to children include: 3 bedrooms, 1 bathroom, and detached garage. LPA observed the bedroom and bathroom doors closed with child safety knobs installed, making the areas inaccessible to children in care. Licensee was reminded that off-limit areas must remain inaccessible to children during operating hours. Upon arrival, LPA observed facility license, parents’ rights, and earthquake preparedness postings in a prominent publicly accessible area.

Areas accessible to children were inspected for safety, comfort, heating, cleanliness, and telephone service. LPA observed electrical outlet covers in the day care areas. In the living room, there is a cooling system installed in and mounted on the and a wall heater. Per licensee, the heater is used to heat the home. LPA observed a

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/07/2024 05:15 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 11/07/2024 at 02:30 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: SUBASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198019180

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

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. In the accessible backyard, LPA observed broken and worn toys inside of children's playhouse and underneath play apparatus. Per licensee, children still play in both areas of the backyard, and the toys are going to be removed. This poses a potential safety risk to persons in care.
POC Due Date: 11/07/2024
Plan of Correction
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Licensee removed broken in worn toys from inside playhouse and from underneath play apparatus. LPA observed that toys were removed.
Type B
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 and lysol toilet cleaner and medications were left on the counter in the kitchen. Per licensee, the kitchen is inacessible via child safety gate and is only used through passing to access backyard. LPA observed that gate does not remain close making the area accessible to children. This poses a potential health and safety risk to persons in care.
POC Due Date: 11/14/2024
Plan of Correction
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Licensee removed cleaners and medication on the countertop and placed it in inaccessible bathroom. Licensee will write statement stating that they have knowledge of the regulation and will keep all hazardous items in areas that are inaccessible to children.
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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


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Document Has Been Signed on 11/07/2024 05:15 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 11/07/2024 at 02:30 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: SUBASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198019180

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
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: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

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 and LPA observed a baby walker in the outdoor play area and informed licensee of regulation. Per licensee, they are aware of the regulation and know that walkers are not allowed, but children do not use it. This poses a potential safety risk to persons in care.
POC Due Date: 11/14/2024
Plan of Correction
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Licensee removed the the baby walker from the home. Licensee will write a statement stating that they will not keep baby walkers at the home while chilldren are in care and email proof to LPA by plan of correction date.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on recorod review, the licensee did not comply with the section cited above in 1 out of 1 infants record reviewed did not have the required documentation. This poses a potential health and safety risk to persons in care.
POC Due Date: 01/02/2025
Plan of Correction
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Licensee will starting documenting infants checks and email proof of documentation for 3 weeks to LPA by plan of correction 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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


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Document Has Been Signed on 11/07/2024 05:15 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 11/07/2024 at 02:30 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: SUBASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198019180

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in 2out of 2 assistants did not completethe madated reported training. Per licensee, they did not do it. This poses a potential safety risk to persons in care.
POC Due Date: 11/21/2024
Plan of Correction
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Licensee will have both assistants complete the training and email LPA training certifications by plan of correction date.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 4 children record's reviewed does not have immunization records. Per licensee, they will have to contact parents for the records. This poses a potential health and safety, and personal rights risk to persons in care.
POC Due Date: 11/14/2024
Plan of Correction
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Licensee will retrieve immunzation records from parents and email proof to LPA by plan of correction 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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SUBASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198019180
VISIT DATE: 11/07/2024
NARRATIVE
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small gate around the heater and a toy storage unit blocking access to the gated heater. LPA advised licensee to barricade heater with something that is not used by children and something that will remain cool while heater is on. Per licensee, the heater does not get hot. Per licensee, there are no firearms, bodies of water, or poisons on the premises. Licensee was advised that if any poisons are purchased, it is to be stored in an area that is inaccessible to children and locked. Telephone service is available via cell phone. Per licensee, when children become ill, their parents are contacted, and the child waits in the living room separated from the other children until parent arrive.

At 2:37pm, In the bathroom, LPA observed Lysol toilet bowl cleaner on the counter. Per licensee, the bathroom is used by children in care. Per licensee, they recently cleaned the toilet, and the door is usually close. LPA observed child safety knob on bathroom door.

At 2: 38pm, LPA observed Lysol toilet bowl cleaner in medications on the kitchen counter. Per licensee, the kitchen is off limits to children, and the safety gate is installed to make sure the area remains inaccessible to children. Per licensee, children only walk through the kitchen to access to the backyard. During visit, LPA observed Child 1 open safety gate making kitchen and hazardous items on the counter accessible to children. This is an immediate health and safety risk to persons in care.

Furniture and equipment were inspected for age appropriateness and good repair. In the living room and dining room, LPA observed age- appropriate tables, chairs, and toys. Per licensee, the two rooms are used for eating, activities, and napping. LPA observed 5 play yards and 4 matts for napping. In two of the play yards, LPA observed blankets, toys, and car seats. Per licensee, the two play yards are used for storage. LPA reminded licensee of safe sleep regulations. In the hallway, LPA observed a 2A 10 BC fire extinguisher fully charged with a purchased date of 10/23/2024. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke and carbon monoxide detectors were not tested during today’s visit, due to children napping.
At 2:42pm, LPA observed worn play tents inside a playhouse and broken bikes underneath children’s play apparatus. Per licensee, children do not play with the broken or worn toys and they are going to throw them out. This is a potential safety risk to persons in care. LPA reminded licensee that they are to provide safe toys and play equipment. Licensee expressed that they would have toys removed.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SUBASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198019180
VISIT DATE: 11/07/2024
NARRATIVE
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At 2:43pm, LPA observed a baby walker in the outdoor play area. Per licensee, the children do not use the walker. LPA reminded licensee that walkers are not permitted on the premises of a family childcare home. This is a potential safety risk to persons in care. Per licensee, they are aware of the regulation and was going to throw the walker out.

Licensee stated that they provide meals and snacks to the children in care. Per Licensee, children do not bring food from home. Licensee was reminded that food brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review 4 children, Licensee, and 3 assistants' records. During record review LPA observed that 4 out of 4 children files were not incomplete. Child 1 is missing Consent to Emergency Treatment (LIC627). Child 2 is missing immunization records and sleep log. Child 3 is missing LIC 627, Notification of Parent’s rights (LIC 995A), and immunization records. Child 4 is missing LIC 627. This is a potential health and safety risk to children in care. LPA reminded licensee to review Entrance Checklist for guidance.

LPA reviewed licensee’s records. License had the required pediatric CPR and first aid training certification with an expiration date of 10/2026. Licensee’s mandated reporter certification completion date is 03/20/2022. LPA observed that 2 out of 2 assistants did not have mandated reporter training. This is a potential safety risk to persons in care. LPA observed that licensee and staff have proof of immunization against pertussis and measles. Facility roster and disaster drill log were available for review. The last drill was conducted on 08/09/2024.

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 Kalyani Subasinghe 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

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SUBASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 198019180
VISIT DATE: 11/07/2024
NARRATIVE
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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.

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-andresources/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.

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/.

MyChildCarePlan.org – Centers and Family Child Care Homes 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, Kalyani Subasinghe, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Six B citations were cited during today's visit in accordance with Title 22, California Code of Regulations. Appeal rights were provided to Licensee. Please see attached LIC 809D. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with the licensee, Kalyani Subasinghe.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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