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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212317
Report Date: 09/02/2026
Date Signed: 09/02/2026 01:31:29 PM

Document Has Been Signed on 09/02/2026 01:31 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FERNANDO FAMILY CHILD CAREFACILITY NUMBER:
566212317
ADMINISTRATOR/
DIRECTOR:		KUMUDU FERNANDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 581-1139
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/02/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Kumudu FernandoTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 9/02/2026 at 11:01AM, Licensing Program Analyst (LPA) Seena Parsapour conducted an unannounced Case Management – Other inspection at the abovementioned Family Child Care Home (FCCH). LPA met with Licensee Kumudu Fernando and explained the nature & purpose of the inspection, which is to address Reporting Requirements for alterations to FCCH grounds, as well as provide best practices and Technical Assistance (TA) to Licensee. At the time of the inspection, LPA observed eight (8) children under the care & supervision of Licensee and one (1) assistant. LPA notes during the annual/random inspection of this FCCH on today’s date, Licensee advised LPA that the attached garage of the residence has been converted to an Accessory Dwelling Unit (ADU). Licensee informed LPA that the ADU, formerly an off-limits attached garage area, remains off-limits from daycare services. During today’s inspection, LPA inspected the ADU and observed it to be unoccupied. LPA observed the ADU to have one (1) designated entrance separate from the main residence. LPA observed the entrance to the ADU was locked during the inspection. LPA also verified with the Simi Valley Building & Safety Division that the ADU is a permitted addition to the main residence.

Per discussion with LPA, Licensee advised that the construction of the ADU was completed in approximately April 2026, and that throughout the duration of the construction, workers were not permitted to interact with children in care nor were they permitted to access any areas of the home used for daycare services. Licensee advised LPA that construction work primarily took place on weekends or otherwise outside of the FCCH operating hours, and that children were able to be dropped off & picked up as usual using the entrance to the main residence, with no construction materials or other hazards present which would have prevented this.

(Cont. 809-C, Page 2)

Maria Mueller
Seena Parsapour
DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2026
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FERNANDO FAMILY CHILD CARE
FACILITY NUMBER: 566212317
VISIT DATE: 09/02/2026
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During today’s inspection, LPA discussed best practices and provided Technical Assistance (TA) regarding Reporting Requirements. Licensee confirmed their understanding that proposed changes to FCCH building or grounds should be reported to the Department prior to the commencement of the construction work, and that the Department must have on file the Licensee’s plan regarding how children in care will be kept safe throughout the construction process. Licensee confirmed their understanding of these requirements.

No deficiencies were cited during today’s inspection. One (1) Technical Violation was issued for Reporting Requirements (See LIC9102TV for details), and LPA provided Technical Assistance to Licensee as well (See LIC9102TA for details).

Appeal Rights were provided to Licensee. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Kumudu Fernando.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC809 (FAS) - (06/04)
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