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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004821
Report Date: 06/30/2022
Date Signed: 06/30/2022 05:01:56 PM

Document Has Been Signed on 06/30/2022 05:01 PM - 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:ABEYGOONESEKERA,AVANTHI DILHARAFACILITY NUMBER:
414004821
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
06/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Avanthi Dilhara Abeygoonesekera TIME COMPLETED:
12:30 PM
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On June 30th, 2022, Licensing Program Analyst's (LPA) Tapia-Mandujano conducted an unannounced inspection for increase of capacity today and met with licensee, Avanthi Dilhara Abeygoonesekera for her request to increase from a Small to a Large Family Child Care. Fire Clearance is still pending from Menlo Park Fire Department. Present in the home are licensee and assistant caring for three children (1 infant and 2 preschoolers).

Licensee rents a three bedroom, one bathroom single-story house with a yard. The hours of operation are from Monday-Friday 8am-5pm. DAY CARE AREA: Living Room, Kitchen, Bedroom #3, Bathroom, and backyard (including deck) OFF LIMITS AREA: Bedroom #1, Bedroom #2, Laundry Room, Garage, front and side yard. All off limit areas are properly barricaded.

LPA observed home to be clean and in good repair with proper temperature and ventilation. There is a variety of age appropriate toys and equipment in the home which are in good condition. There are no pools, spas, or bodies of water on the property. Home has a fireplace that is properly barricaded. Backyard and Side yard is fenced and properly barricaded leading to off limit areas. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a fully charged fire extinguisher, and a working telephone. Per Licensee, there are no weapons or firearms in the home. Licensee has a pet cat with current records. Licensee's CPR & First Aid expires on 05/2023. Licensee's Mandated Reporter certificate expires on 06/2023. Postings were posted near main door. Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Capacity limits of a Small and Large Family Child Care Home were explained.

Prior for approval of a Large Family Child Care Home License, the following must be completed:
*Fire Clearance approved by Menlo Park Fire Department
*Landlord Consent (LIC 9149)

Report was reviewed with licensee, Avanthi Dilhara Abeygoonesekera. This report must be available in the facility for public review. Any additional questions to call Office, M-F, 8am-5pm, 650-
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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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