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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021447
Report Date: 06/04/2024
Date Signed: 06/04/2024 10:32:59 AM

Document Has Been Signed on 06/04/2024 10:32 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WIJEWARDANE FAMILY DAY CAREFACILITY NUMBER:
198021447
ADMINISTRATOR/
DIRECTOR:		WIJEWARDANE, BHAGYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 303-7273
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Bhagya Wijenwardane, ApplicantTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 06/04/2024, Licensing Program Analyst (LPA) Kruz Long conducted an announced Prelicensing Inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with the applicant Bhagya Wijenwardane who guided LPA on a tour of the facility. This is a single story home with a Living room, dining area, kitchen, 3 bedrooms, 2 bathrooms and an attached converted garage. Days and hours of operation will be Monday to Friday from 6:30am to 6pm.

Main care is provided: Living room, dining area, hallway bathroom, rear and side yard.
Off limit areas: Kitchen, 3 bedrooms, master bedroom bathroom, front yard and attached converted garage.

Per applicant there are no pets, no weapons or firearms on the premise. The home is clean and well ventilated. There are age appropriate toys (blocks, dramatic play area, slides, kitchen set). Age appropriate napping equipment (cots, crib and playpens). Smoke/Carbon Monoxide detectors located in the living room and kitchen is operable. The required fire extinguisher (2A10BC) is fully charged. Home has central AC and heat. CPR/First Aid expire 04/30/26. Barricades between the kitchen and dining are, hallway and living room was observed. Children will sleep on the cots, crib and playpens. Breakfast, lunch and snacks will be provided. Fireplace is not in use. A book shelf barrier is place in front of the fire place. Parents/Guardians will drop off and pick up children through the front entrance. Per Licensee, English will be the primary language used during child care. The home contains a cell phone. Cleaning compounds and knives are locked under the kitchen sink. Fire Clearance was granted on 04/19/24. Licensee prefers to provide care for infants to age 12. There is a pool and an empty pond in the rear yard which is surrounded by a 5 feet high chain linked fence with a gate that is not self latching.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WIJEWARDANE FAMILY DAY CARE
FACILITY NUMBER: 198021447
VISIT DATE: 06/04/2024
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LPA observed the following item which needs correction:

1. Per Applicant, a mesh fence with a self latching gate will replace the current chain linked fence surrounding the pool.

The following was discussed with the Applicant:


Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names and blue sheet), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, Safe Sleep and information on shaking baby syndrome. The role and responsibilities of being a mandated reporter were reviewed. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Applicant advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

Requirements for fingerprint clearances and associations were discussed with the Applicant. Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B (Same day/ASAP or within next business day within normal business hours 8-5 and written report within 7 days). Pamphlet providing Information regarding, Seat Belt Safety and Notification of Parent's Rights poster (Monterey Park Regional Child Care Office) was provided. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WIJEWARDANE FAMILY DAY CARE
FACILITY NUMBER: 198021447
VISIT DATE: 06/04/2024
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Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

Applicant informed to review Quarterly updates/regulations for 2015-2023 on the department website: Summer 2015 - Incidental Medical Services information.



--Applicant was advised visit www.shotsforschool.org for Immunization information.
--Applicant was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Family Child Care Providers (Disaster Planning information): https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/

https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/


--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Applicant was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.

LPAs 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. 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.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WIJEWARDANE FAMILY DAY CARE
FACILITY NUMBER: 198021447
VISIT DATE: 06/04/2024
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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 Centers and the ADA, available at: http://www.ada.gov/childqanda.html (Plan is on file or currently no plan on file).

LPA informed Applicant that the licensing process will proceed once proof of correction is provided.

An exit interview was conducted and a copy of this report was provided to the applicant on this date.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
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