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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020049
Report Date: 05/02/2024
Date Signed: 05/02/2024 03:01:34 PM

Document Has Been Signed on 05/02/2024 03:01 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HEWA RAHINDUWAGE FAMILY CHILD CAREFACILITY NUMBER:
198020049
ADMINISTRATOR/
DIRECTOR:		DINESHA HEWARAHINDUWAGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 387-6737
CITY:LAKEWOODSTATE: CAZIP CODE:
90715
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
05/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Dinesha HewarahinduwageTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Licensing Program Analysts (LPAs)Jonnisha Culbert and Jeanette Estrada conducted an Unannounced Required Annual inspection to the above facility. Upon arrival, LPAs disclosed the purpose of the inspection and met with Licensee, Dinesha Hewarahinduwage. Licensee was given an Entrance Checklist (LIC126). Licensee then guided LPAs on a tour of the facility. Present during today's inspection were 8 children, including 4 infants, Staff 1 and Adult 1. LPAs verified that Staff 1 has obtained a criminal record clearance. Based on review of the personnel roster, Adult 1 does not have a criminal record clearance. This is an immediate risk to the safety of children in care. During inspection LPAs observed Adult 1 providing care in the day care area. Adult 1 was observed holding and bottle feeding Child 1 (infant). Licensee stated that Adult 1 is her mother in law who is visiting the country for 6 months and has been staying in her home for 1 month. Per Licensee, Adult 1 is staying with her for a total of 3 months. LPAs advised licensee that only adults with a criminal record clearance shall provide care to children. Adult 1 was observed entering the off-limits portion of the home.
Per Licensee here are three adults residing in the home, including Adult 1. All other adults residing in the home have obtained a criminal record clearance.
Licensee states that there are currently ten children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 7am to 6pm, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted 03/15/2024.
This is a single story home which consists of three bedrooms and two bathrooms, kitchen, living room, and den. At 10:10 AM, LPA observed there is a fireplace in the home that is barricaded by a gate. Areas used by the children include the living room, one restroom, and den(day care space) and a section of the backyard. Per Licensee, areas off limits to children and parents include all three bedrooms, Bathroom 2 (located inside a bedroom), and kitchen. At 10:12 AM, LPA observed that there is an operable baby gate blocking hallway to all three bedrooms and the entrance to kitchen making these areas off limits to children in care at time of inspection.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HEWA RAHINDUWAGE FAMILY CHILD CARE
FACILITY NUMBER: 198020049
VISIT DATE: 05/02/2024
NARRATIVE
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All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety of the children. The facility has central air and heating. Living room is located upon entrance of the home. Children are guided through the living room to den in the back of the home which is the main day care are. LPAs observed age appropriate materials and toys for children. No hazards were observed in these areas. There is a working telephone maintained in the home. At 10:13 AM, LPAs observed four playyards near Bathroom 1 which is used by the children, to the left of day care space. Per licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, and pesticides are kept above the washer and dryer in a cabinet in the off limits gated area of home. Medication is kept in upper hallway cabinet in gated off limits area. LPAs observed these items to be kept in high shelves in off limits kitchen and hallway. Licensee was advised that per regulation all poison should be locked away in an inaccessible area.
Per licensee, the children have access to backyard area through glass sliding glass door in day care space. LPAs observed backyard has turf grass and adequate perimeter fencing through-out the yard, per Licensee the left side of yard is off limits and LPAs observed an operable baby gate that is bolted to the house making area off limits to children in care at time of inspection. LPA observed small plastic slides, plastic play house, plastic ride along toy, and other age appropriate toys free of loose and sharp parts available for the children in the backyard.
Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any of these items. Per Licensee, they provide food for children in care. Licensee states that isolation area is the Living Room where children wait to be picked up.

LPA observed the required 2A 10BC fire extinguisher with a receipt date of 09/26/2021. Licensee expressed that extinguisher has not been serviced or replaced since the day of purchase. This poses a potential health and safety risk to children in care. Smoke and carbon monoxide detectors are in operable condition. LPAs observed first aid kit kept in upper cabinet in the hallway. Children and staff files was reviewed. The Licensee has current EMSA Approved Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 03/20/25
—Mandated Reporter AB1207 Completed: 01/21/2026 Staff 1 does not have child care provider portion
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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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: HEWA RAHINDUWAGE FAMILY CHILD CARE
FACILITY NUMBER: 198020049
VISIT DATE: 05/02/2024
NARRATIVE
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Currently Licensee does have infants enrolled. LPA discussed the safe sleep regulations with the 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. Licensee 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.
LPAs 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 Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center 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, the Licensee Dinesha Hewarahinuwage confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO in FAS.

A type A citation and an immediate $100 civil penalty are being issued today for Adult 1 not having obtained a criminal record clearance prior to providing care. A type B citation is being issued today for the fire extinguisher which has not been serviced since 2021. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC 809 D


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

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/02/2024 03:01 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 05/02/2024 at 12:51 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: HEWA RAHINDUWAGE FAMILY CHILD CARE
FACILITY NUMBER: 198020049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

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 1out of 3 adults present during today's inspection who were providing care. Adult 1 does not have a criminal record clearance which poses an immediate safety risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
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Licensee stated they will either have Adult 1 obtain a criminal record clearance or they will submit a declaration stating that Adult 1 will not provide care and will remain in off limit areas during hours of operation by 5/3/24. Proof of either item will be submitted to LPA via email.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


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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: HEWA RAHINDUWAGE FAMILY CHILD CARE
FACILITY NUMBER: 198020049
VISIT DATE: 05/02/2024
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A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.


Appeal rights provided to Licensee.
Exit interview was conducted and report reviewed with the Licensee (or facility representative), Dinesha HEWA RAHINDUWAGE
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/02/2024 03:01 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 05/02/2024 at 01:13 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: HEWA RAHINDUWAGE FAMILY CHILD CARE
FACILITY NUMBER: 198020049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
102417(g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
(1) ...The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.

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 1 out of 1 fire extinguishers was not replaced of serviced since 2021 which poses a potential safety risk to persons in care.
POC Due Date: 05/13/2024
Plan of Correction
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Licensee will provide proof of serviced fire extinguisher or purchase receipt for a new one.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


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