198400910-1-12-2024-54-CC-WBIS-CZEQXV-20240112113411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400910
Report Date: 01/12/2024
Date Signed: 01/12/2024 11:34:36 AM

Document Has Been Signed on 01/12/2024 11:34 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:	FONSEKA FAMILY CHILD CARE		FACILITY NUMBER:	198400910
ADMINISTRATOR:	FONSEKA, SUBHADRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 905-0049
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90713
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	01/12/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Subhadra Fonseka		TIME COMPLETED:	11:48 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Warren Birks conducted a pre-licensing inspection and met with Applicant Subhadra Fonseka who guided analyst on a tour of facility. The applicant is requesting a Large Family Child Care license (with a capacity of 12 to 14 children). Applicant provided proof of Teacher Qualifications for a Large child care. Applicant indicated that she will care for children ages one (1) year old to six (6) and will operate from Monday-Friday 7:30am to 5:30pm. An Entrance Checklist was discussed and all individuals residing in the home were notated. All areas of the facility sketch were inspected. This is a one story home consisting of three bedrooms, two bathrooms, kitchen, living room, family room, backyard and garage. Primary care will take place in the family room, living room, dining area, one restroom, patio, backyard and gated driveway. Note the kitchen serves as a walk through to the restroom. LPA informed applicant to keep the kitchen area free of inaccessible hazardous items (knives, chemicals, sprays, medicine and any other kitchen hazards). Areas used by children include: family room, living room, dining area, one restroom, patio, backyard and gated driveway. Areas off limits include: All bedrooms, and the garage. Per applicant, the children will use the bathroom located near the kitchen and off limit rooms will be made inaccessible by locks or door knob covers. LPA inspected all areas used by children for safety, comfort, cleanliness, telephone service, ventilation and heating. The applicant was advised that any poisons must be locked with a key or combination lock. Note: LPA observed the home to have age appropriate toys and books available for children. Applicant also has sleeping equipment for infants and will purchase more as needed. LPA observed a fireplace in the family room that is covered and inaccessible. The backyard is surrounded by 4 foot fencing and gates. LPA advised applicant to provide extra care and supervision to prevent children from climbing the smaller four ft fence during outdoor play.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

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 3

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: FONSEKA FAMILY CHILD CARE	FACILITY NUMBER: 198400910
	VISIT DATE: 01/12/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed the backyard is free of uncommon hazards and has a gated driveway that will be used as a play area for tricycles. LPA received a declaration that no vehicles will be parked in the gated driveway. The applicant understands that licensing staff may have access to off-limit areas during inspections is if necessary. Firearms were discussed. Per applicant, there are no bodies of water on the premises and none were observed. The applicant has no pets at this time. LPA advised applicant to provide additional supervision if she ever has pets (as animals can be unpredictable around children). The applicant was informed items such as medicine, toothpaste, nail polish, hand sanitizer, cleaners, bleach and similar items must always remain inaccessible.

The valve on the 2A10BC fire extinguisher indicates fully charged and is due for service August 15th, 2024. Annual service is required or a new extinguisher must be purchased every year. LPA observed and tested smoke and carbon monoxide detectors near the hallway and they were in operable condition.

Applicant states that she will provide snacks and parents will provide lunch and she will have back up food/snacks if necessary. LPA informed applicant to ensure that food brought from home is labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition & Lead Training and Pediatric First Aid and CPR which expires 09/16/2025. Licensee has first aid supplies available. The applicant has the required Mandated Reporter training that is set to Expire March 2025.

Applicant was reminded of all the terms and conditions noted on the LIC 279 – Application of a Family Child Care Home that applicant signed and agreed to.

Applicant states that they will care for infants. LPA advised the applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. Applicant states that infants will sleep in the living room or den and will provide supervision sometimes directly and document 15 minute checks. LPA discussed copy PIN 20-24-CCP and LIC 9227 to Applicant. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage:

https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: FONSEKA FAMILY CHILD CARE	FACILITY NUMBER: 198400910
	VISIT DATE: 01/12/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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

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.

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.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. Based on documentation and inspection, the applicant will be approved for a Large Family Child Care License once the following is completed:

1. Temporary visiting (out of state) family member receives a live-scan fingerprint clearance or the Department can issue the License once the we have proof the adult no longer stays in the facility.

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. Exit interview was conducted with Applicant Subhadra Fonseka. This report along with appeal rights were provided.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3