414004821-10-24-2025-05-CC-KKRN-DMRV7A-20251024161048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004821
Report Date: 10/24/2025
Date Signed: 10/24/2025 04:12:16 PM

Document Has Been Signed on 10/24/2025 04:12 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ABEYGOONESEKERA,AVANTHI DILHARA		FACILITY NUMBER:	414004821
ADMINISTRATOR/ DIRECTOR:	ABEYGOONESEKERA, AVANTHI D		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 289-0945
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	10/24/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Avanthi Abeygoneskera		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

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	On October 24, 2025 at approximately 8:00AM, Licensing Program Analyst (LPA) Katie Krenn conducted an unannounced annual visit. Upon arrival LPA observed through the blinds by the front door three adults and children in care. LPA did not observe the licensee. LPA waved at the adults and one of the adults came over the window. LPA held their badge on the window, so the adult could see. The adult looked at the badge. After looking at the badge the adult closed the blinds. LPA called the licensee’s phone number. The licensee did not answer. A different adult came to the door. LPA introduced themselves and explained the purpose of the day’s visit. The adult stated that the licensee was not present. LPA explained that licensing analysts have inspection authority when children are in care, even if the licensee is not present. The adult permitted LPA to enter. LPA counted 12 children present. Two of the adults were identified as staff and the third adult was a parent. The licensee, Avanthi Abeygoneskera called the LPA and explained that they would arrive soon. Licensee arrived within 30 minutes of LPA’s arrival. LPA explained the purpose of today’s visit was an annual inspection. Present during the visit, were three staff supervising two infants and ten children in care. During the visit a parent and their own child were at the home evaluating it prior to placement. During the visit a speech therapist came to work with one of the children in care. All adults living and working in the home have obtained criminal record clearances from the California Department of Social Services. The licensee has a large license and is operating within the capacity limits and ratios for this visit. Days and hours of operation are Monday – Friday from 8:00AM- 5:30PM continued on page 2

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ABEYGOONESEKERA,AVANTHI DILHARA	FACILITY NUMBER: 414004821
	VISIT DATE: 10/24/2025

NARRATIVE

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Daycare Areas: The main Living Room Area, the Backyard, the Kitchen, the Front Yard, the Southeast Side Yard, Bathroom 1, Bedroom 3, and Bedroom 2.
Off-limit Areas: Garage, Northwest Side Yard, Bedroom 1, and Laundry Room (as a pass through only).

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed and visible to the public.

The most recent emergency disaster drill was conducted in October 2025, and the LPA observed that it was documented. LPA reviewed the emergency disaster drill log and found they were conducted at least once every six months.

LPA inspected the indoor and outdoor daycare areas to identify health and safety hazards. The home had a fire extinguisher, a first aid kit, and several combination carbon monoxide and smoke detectors. LPA tested the combo carbon monoxide/smoke detectors and found them to be functioning. About a half hour one of the detectors started beeping and would not stop. Licensee removed it. Licensee will keep the door for that bedroom open until they replace it. There is a functioning detector in the hallway, just outside the bedroom door.

LPA observed that the home's interior was clean and orderly, with proper heating and ventilation. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children. The bathroom was clean, fully operational, and equipped with suitable toileting equipment and sanitation products.

LPA observed that the daycare areas had Montessori age-appropriate toys, furniture, and educational materials. The fireplace was covered with furniture. A designated area was provided for permanent or portable storage of the children's clothing and personal belongings. LPA did not observe any accessible electrical outlets. According to the licensee, there are no firearms or weapons on the property.

The backyard is surrounded by a fence and features a variety of outdoor play equipment, all of which are in excellent condition. Areas around and under slides and climbing equipment are cushioned with tanbark. LPA advises licensee to replenish the tanbark. The stairs to the deck are properly barricaded.
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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ABEYGOONESEKERA,AVANTHI DILHARA	FACILITY NUMBER: 414004821
	VISIT DATE: 10/24/2025

NARRATIVE

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The licensee stated she currently provides lunch and snacks for the children. The licensee stated that one of the enrolled children have documented allergies. LPA observed that medication was stored centrally and labeled appropriately. LPA observed that the epinephrine pen expired this month. Licensee said that they would inform the parents.

The facility offers mats for children to rest or nap. LPA observed that bedding is available for the children. LPA observed that the bedding is stored in bags which are labeled for each child. Mats are wiped down daily and set to air dry. Per licensee, she provides the sheets and washes them onsite. The blankets are provided from home and go home weekly for washing.

LPA reviewed the files of five children and confirmed that all necessary forms were present and completed for each child. LPA reminded licensee that it is important to remind parents to bring updated immunization records.

LPA reviewed the files of all three staff present today and the licensee’s personal file. LPA confirmed that all necessary forms were present and completed. LPA confirmed that the licensee and all staff present hold valid Pediatric First Aid/CPR certification and Mandated Reporter Training Certification. LPA observed that all staff have complete vaccination records.

Licensee 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.

To improve the quality and value of the inspection process, a survey will be sent to the email address provide. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/‌inspection-process.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ABEYGOONESEKERA,AVANTHI DILHARA	FACILITY NUMBER: 414004821
	VISIT DATE: 10/24/2025

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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 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.

No deficiencies were cited today during LPA's visit.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Avanthi Abeygoneskera.

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025

LIC809 (FAS) - (06/04)

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