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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401908
Report Date: 05/16/2024
Date Signed: 05/16/2024 05:32:20 PM

Document Has Been Signed on 05/16/2024 05:32 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:JAYASINGHE FAMILY DAY CAREFACILITY NUMBER:
197401908
ADMINISTRATOR/
DIRECTOR:		JAYASINGHE, ARUNIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 832-5051
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 12TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
05/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:38 PM
MET WITH:Aruni Jayasinghe, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced annual required inspection to the above facility on 05/16/2024. LPA arrived at the facility at 12:38 PM, identified self and met with Aruni Jayasinghe, Licensee, who guided analyst on a tour of the inside and outside of the facility. There were 9 children present and 1 Assistant upon arrival. LPA provided Licensee with a copy of the LIC125 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 08:00 AM to 5:30 PM.

The family child care home is a two-story dwelling with living room, dining room, kitchen, den, 5 bedrooms, 5 bathrooms, covered patio (behind house), covered patio (next to garage), and attached garage. LPA toured the home inside and outside and a census was taken.

Current facility sketch reviewed, the floor plan sketch was incomplete in that it did indicate areas used for child care, areas off limits during operation hours, no second-floor sketch and the facility sketch (Yard) was incomplete in that it did not indicate a play yard (near garage) or indicated off limits areas.

Licensee confirmed that kitchen, den, bedroom #4, attached garage, covered patio (near garage) and restroom (in bedroom #4) are used for child care activities and are accessible to children. Per licensee, the attached garage is used from 10:00 AM- 11:30 AM daily for circle time, school work, crafts, and other activities. LPA observed appropriate toys, furniture, and play equipment for children in care.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JAYASINGHE FAMILY DAY CARE
FACILITY NUMBER: 197401908
VISIT DATE: 05/16/2024
NARRATIVE
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The outdoor play area located on the side of the house near the garage was fenced and there were no hazards to children present. LPA observed appropriate toys, play equipment, and climbing structure with swings and a slide. The children use the bathroom located inside bedroom #4 and was observed to be safe and sanitary. There is telephone service via a landline that is used by the facility during operation hours. The licensee provides food for children in care. All areas identified that are accessible for children to use were inspected for safety, comfort, and cleanliness. The front yard is fenced and is used for parents and children to enter the home, there are no hazards to children present.

Per Licensee, the areas off limits to children and parents inside the home are second floor bedroom #1, bedroom #2, master bedroom, 3 second floor bathrooms living room, dining room, kitchen, covered patio (behind house) and backyard. The second floor is made inaccessible by the use of child gate at the bottom of the stairs. The kitchen is off limits and made inaccessible by use of child proof drawer locks. The back yard behind the house is made inaccessible with the use of a gate and lock at the side of the house (photo taken).

LPA did observed pool during the inspection. There is a fenced pool and Aruni Jayasinghe, Licensee confirmed that the fencing will remain in place whenever licensed care is provided, and so long as the fence makes the swimming pool inaccessible to children as determined by licensing staff.

LPA observed the pool is under construction, undergoing a remodel, and no water inside the pool. Licensee stated they did not report the pool construction and remodel to the department. LPA observed the children in do no have direct access to the back yard and the play yard use for children has gate and lock so that makes the back yard inaccessible to children. The fence is designed and installed so children could not remove any portion of it, it completely surrounds the pool, is constructed so that it does not obscure the pool from view, no window or door provides direct access to the pool. Fence is at least 5 feet high (photo taken). The gate swings away from the pool, self closes, and self-latch. The opening between the railing does not exceed 4 inches.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JAYASINGHE FAMILY DAY CARE
FACILITY NUMBER: 197401908
VISIT DATE: 05/16/2024
NARRATIVE
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Per Licensee, there are no firearms or ammunition on the premises. Per Licensee, there are no poisons kept in on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There are no pets on the premises.

There is a working 2A 10BC fire extinguisher and the value indicates fully charged and was serviced on 01/24/2024, as indicated on service tag. The smoke detector / carbon monoxide detector (located by bedroom #4) was tested and operable. There was adequate heating and ventilation for safety and comfort. LPA observe two fireplaces, the living room fireplace is enclosed in the wall and is made inaccessible to children and the 2nd fireplace located in the den has a screen with a child lock. LPA did not observe an open face heater.

There are currently no infants in care. 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.

Licensee was reminded that children in care are always supervised all the time and made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete and documented on the LIC857.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JAYASINGHE FAMILY DAY CARE
FACILITY NUMBER: 197401908
VISIT DATE: 05/16/2024
NARRATIVE
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All homes shall conduct fire and disaster emergency drills at least once every six months and document the date and time of each drill. Last fire and disaster emergency drill was completed and documented on 12/15/2023. Licensee’s Mandated Reporter Training was completed on 2020 and has expired Licensee’s pediatric CPR/First Aid expires on 06/25/2025.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

There were one personnel record for LPA to review and observed files were not complete and documented on LIC859. Staff #1's Immunization records were not readily available upon request.

Emergency Disaster Plan (LIC 610A), Parent’s Rights Poster (PUB 394), Earthquake Preparedness (LIC 9148) and the Facility License were observed to be posted.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



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: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JAYASINGHE FAMILY DAY CARE
FACILITY NUMBER: 197401908
VISIT DATE: 05/16/2024
NARRATIVE
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During the exit interview, Aruni Jayasinghe, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms.

To receive important licensed 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 to receive email communication.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries 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.

At this time, the licensee is not compliance with California Code of Regulations Title 22 and deficiencies were cited on the attachments..

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.


Exit interview conducted, report and appeal rights was reviewed with the Aruni Jayasighe, Licensee.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 05/16/2024 05:32 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 05/16/2024 at 04:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JAYASINGHE FAMILY DAY CARE
FACILITY NUMBER: 197401908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that Aruni Jayasinghe Mandated Reporter Certificate has expired and was not readily available upon request which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee stated they will complete the Mandated Report Training and provided LPA Calvillo a copy of the completed certification by the plan of correction due date 05/31/2024.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that there were changes to the child care areas use for children and an updated Facility Sketch Floor Plan and Yard were not readily available upon request which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee stated they will update the Facility Sketch Floor Plan and Yard, provide LPA Cavillo with a copy of the updated sketches, mail the original documents to the Regional Office by the plan of correction due date 05/31/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 05/16/2024 05:32 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 05/16/2024 at 04:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JAYASINGHE FAMILY DAY CARE
FACILITY NUMBER: 197401908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in Staff #1 did not have Immunization Record readily available upon request, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee stated Staff #1 will provided a copy of the Immunization Record and License will send a copy to LPA Calvillo by the plan of correction due date 05/31/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
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