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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313980
Report Date: 10/19/2022
Date Signed: 10/19/2022 11:31:52 AM

Document Has Been Signed on 10/19/2022 11:31 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEELARATNE, SUMUDUFACILITY NUMBER:
304313980
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/19/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:LicenseeTIME COMPLETED:
12:00 PM
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A Case Management (Licensee initiated) inspection for a change in capacity was conducted at the facility by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek. LPA observed licensee, Sumudu Leelaratne was caring for one child under 24 months old. Another child (21 months old) arrived during LPA's inspection. LPA also met with licensee's spouse, Manuka Leelaratne. Licensee has been a care provider for a Small Family child care home since July 2018, qualifying her to be a Large Family child care provider.

Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Licensee stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. She was reminded if changes to notify the licensing office.

Per Licensee, operation hours will be Monday to Friday from 7:30 AM to 5:30 PM, care and supervision will be provided to children ages birth to 10 years old.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. Off Limit areas: 3 bedrooms and 2 bathrooms located in the upstairs area of the home. Licensee has made this areas inaccessible by installing a baby gate in front of the stairs.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEELARATNE, SUMUDU
FACILITY NUMBER: 304313980
VISIT DATE: 10/19/2022
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Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children.

Designated Day care area: Parents and children will enter the home, through the main door leading into the children's area. Licensee continues to use family room and children's bathroom in the downstairs area. The bathroom is located in the downstairs area. There is a cabinet under the sink with no hazardous items. The Family room is the designated child care room. There are age appropriate toys for all ages to be served, arts and craft materials, books and educational items are arranged. Age appropriate furniture is observed in this room. There is pack and play for infants' sleeping. Older children will nap in the day care room on a soft mats. Sheets and blankets are provided by the provider. The licensee was advised that infants are needed to be checked every 15 minutes and shall be recorded on a log. A sample of the log was given to licensee.

LPA's discussed the Safe Sleep practice with the Licensee Sumudu Leelaratne.


Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.
Licensee shall maintain LIC 9227 form in the infant file. ( Printed and given to the Licensee)
Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEELARATNE, SUMUDU
FACILITY NUMBER: 304313980
VISIT DATE: 10/19/2022
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Outdoor activity area: Licensee continues to use the open back yard for children. It is all fenced with concrete flooring covered in carpet and grass area. There are two baby gates that have barricaded the side yards and made them inaccessible to children. There is a Jacuzzi on the off limit area which there is a baby gate with lock on it to make it inaccessible to children. The jacuzzi was inspected and was observed it was covered and locked with four locks on the four sides of it.


There are two guinea pigs kept in garage. Garage is inaccessible to children by two different locks.

There are no firearms, weapons in the home.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

LPA verified there is a working telephone service (cellular service) in the home.



The licensee does have a current roster of children in care and one child's file was reviewed on today's inspection and found to be in compliance.
The licensee holds a valid Pediatric CPR/First Aid certification is valid through 9/2024 and has completed the required Mandated Reporter Child Abuse training.

LPA verified the Control of Property and is on file.

The licensee understands she must be present in the facility, must ensure children in care are supervised at all times, and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR/First Aid, and mandated reporter training.

A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

OTHER INFORMATION AND FORMS PROVIDED:
Capacity Handout for a Large Family Child Care Home was provided.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEELARATNE, SUMUDU
FACILITY NUMBER: 304313980
VISIT DATE: 10/19/2022
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Fire inspection from Orange County Fire Authority Fire inspection services have granted the fire clearance approval.
LPA discussed the following items with the Licensee, Sumudu Leelaratne during the exit interview:

Criminal Record statement: Licensee, Sumudu Leelaratne 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.

Safe Sleep : LPA discussed the safe sleep regulations with Licensee, Sumudu Leelaratne & 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 of the Licensee, Sumudu Leelaratne 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: 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.

Review of records to be maintained : LPA reviewed with licensee, Sumudu Leelaratne 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.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEELARATNE, SUMUDU
FACILITY NUMBER: 304313980
VISIT DATE: 10/19/2022
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Subscribe to CCLD important information
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 license- 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

LPA discussed the ratio for the Large Family Child Care home with the Licensee: Large Family Child Care Home, and with an assistant provider, may provide care for more than 12 and up to 14 children when one child is enrolled in and attending kindergarten (including transitional kindergarten) or elementary school, and another child is at least six years old, and no more than three infants are in care.

( Poster given to the Provider)


A license with the change in capacity for 14 children (Large Family Child care home) will be issued after final review and management approval.


A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

A copy of this report and Appeal rights were presented to the Licensee.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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