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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
214005601
Report Date:
10/12/2021
Date Signed:
10/13/2021 09:05:26 AM
Document Has Been Signed on
10/13/2021 09:05 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
,
851 TRAEGER AVE., SUITE 360
SAN BRUNO
,
CA
94066
FACILITY NAME:
DE SILVA, NIROSHA
FACILITY NUMBER:
214005601
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
6
DATE:
10/12/2021
TYPE OF VISIT:
Prelicensing
ANNOUNCED
TIME BEGAN:
12:50 PM
MET WITH:
Nirosha De Silva
TIME COMPLETED:
02:05 PM
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Licensing Program Analysts (LPA) Haydee Caliboso met with Nirosha De Silva today for a follow up pre-licensing inspection required prior to licensure during the initial Pre-Licensing inspection conducted on 9/28/21. Present during the inspection were 6 children and 3 staff. LPA observed the following corrections have been completed:
·
Garage area "toy room" will not be used and shall be maintained off limit for day care children during the hours of care.
·
Updated LIC 999A facility sketch indicating garage is off limit.
·
Garage will only be use for passageway only during the hours of care.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.
LPA Caliboso will recommend licensure of this facility for a capacity of 14 children.
SUPERVISORS NAME
:
Cindy Interiano
LICENSING EVALUATOR NAME
:
Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/12/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/12/2021
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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