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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400574
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:36:21 AM

Document Has Been Signed on 06/13/2022 11:36 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RANAWEERA FAMILY CHILD CAREFACILITY NUMBER:
198400574
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gishani Ranaweera, ApplicantTIME COMPLETED:
11:45 AM
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On 6/13/22 at 10:00am. Licensing Program Analysts (LPAs) Alicia Mooberry and Austin Estrada conducted a pre-licensing inspection for the above address. LPA met with Gishani Ranaweera, Applicant, who guided LPA on a tour of the facility. Individuals residing in the home were discussed and noted. Per Applicant, hours of operation will be Monday - Sunday, 24 hours not to exceed 24 hour care at one time. Applicant states they will care for children Infants - 6 years of age. A plan for overnight care will be created for children that are staying overnight. Entrance Checklist was provided to the applicant.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, living room, kitchen, dining room with laundry area, attached converted garage, backyard (fenced). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children in care.

Areas used by children include: Living Room and dining room (main daycare areas), bathroom, and back yard.

Areas off limits include: 2 bedrooms, kitchen and garage.

The off limit areas are maintained inaccessible by a safety gates in the kitchen and door safety locks for the bedrooms and garage. Knives and other sharp utensils are located in kitchen inaccessible to children in care. Cleaning products were located in cabinets locked with safety latches under the sink in kitchen and bathroom. There are outlet covers throughout the home.

The home was observed to be clean and orderly. LPA observed age appropriate toys and learning materials in the daycare area. First Aid and emergency supplies are available located in Dining room.

LPA observed the required 2A10 BC fire extinguisher with purchase receipt dated 6/9/22. Applicant was reminded that fire extinguishers need to be purchased or serviced yearly. Smoke and carbon monoxide detectors were tested and are operable. ------Page 1

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RANAWEERA FAMILY CHILD CARE
FACILITY NUMBER: 198400574
VISIT DATE: 06/13/2022
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The home has central air and heating.

The applicant states that meals will be provided by facility and parents will also have the option to bring food from home. Applicant was informed that any food brought from the children’s homes must be labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training 05/21 and Pediatric First Aid/CPR expire on 9/29/23. Required immunization's are current.


Per Applicant, there are no weapons or firearms in the facility, none were observed by LPA. Applicant has no pets at this time.
Per applicant, the back yard will be used as outdoor play area. The yards are enclosed with shade and grassy play area. Safe and age appropriate toys were available. There are no bodies of water on the premises and there are no pets.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

LPA discussed the Safe Sleep Regulation and provided PIN 20-24-CCP and Infant Sleep Plan LIC 9227 for when Applicant is ready to enroll infants. Children will nap in dining room and living , mats and a crib are available.

LPA discussed the safe sleep regulations with applicant 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.
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: http://www.ada.gov/childqanda.htm

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RANAWEERA FAMILY CHILD CARE
FACILITY NUMBER: 198400574
VISIT DATE: 06/13/2022
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Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

The following corrections need to be made prior to obtaining a small family child care license.
Proof of corrections are due by 6/17/22
1. Applicant will purchase a tight fitting sheet for the mattress in playpen.
2. Applicant will provide cots/mats for children in care to sleep on.

A Small Family Child Care Home licensee will be granted after a final review of the application and corrections. The applicant is required to follow the Title 22 regulation upon receiving the license.
Exit interview was conducted with Gishani Ranaweera, Applicant.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RANAWEERA FAMILY CHILD CARE
FACILITY NUMBER: 198400574
VISIT DATE: 06/13/2022
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LPA Provided COVID-19 Technical Assistance by emailing applicant COVID-19 resources. LPA advised applicant to ensure they are following the guidance from the local health authorities in order to prevent and reduce the transmission of diseases. LPA informed applicant to call the Regional Office if there are any Positive COVID cased in the daycare home.

The following was discussed with the applicant:

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to the facility license.

-A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer attending the facility.


-Unusual incident or any changes will be reported to Licensing within 24 hours and an LIC 624B will be submitted within 7 days.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4