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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414315
Report Date: 12/13/2023
Date Signed: 12/13/2023 03:26:53 PM

Document Has Been Signed on 12/13/2023 03:26 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GARUSINGHE FAMILY CHILD CAREFACILITY NUMBER:
197414315
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
12/13/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Licensee Sujani GarusingheTIME COMPLETED:
03:45 PM
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On 12/13/2023 at 1:40pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an announced case management inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observed 3 children in care and two staff providing care and supervision (fingerprint cleared and associated to the home.) Licensee has applied for a capacity increase to care for 14 children, increasing from a small to a large family child care home. The local fire department has inspected and granted a fire clearance.

The operational childcare hours are Monday through Friday from 7:00am to 5:00pm, varied up to 23 hours depending on family's need.

Present during the time of inspection is the Licensee, 1 assistant and 3 child care children.
Licensee is reminded with a capacity increase they must have a qualified assistant present at all times whenever more than 8 children are in care. Licensee is also provided the capacity increase requirements: a maximum of 14 children, no more than 4 infants (0-24mths) and 8 older children over the age of 2 with a qualified assistant (aged 14 yr/old or older) OR no more than 3 infants in care (0-24mths) and 11 older children with at least two school age children with one child enrolled in Kindergarten/transitional kindergarten/elementary school, one child at least 6 years of age, and a qualified assistant. Licensee is aware that if no qualified assistant is present, then they must follow the capacity requirements of a Small Family Child Care Home regulations.

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARUSINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197414315
VISIT DATE: 12/13/2023
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Indoor Area:
This is a two-story house with 4 bedrooms, 3 bathrooms, kitchen, family room, living room, play room, and attached garage made inaccessible with lock. Per the Licensee, the living room, family room, play room, kitchen, one bathroom, and backyard is utilized for the family child care activity area. Per the Licensee, the off-limit areas of the home are the 4 bedrooms, 2 bathrooms, and garage. Licensee does provide napping but does not have bedding for the large capacity home yet, this is an inefficiency. Licensee provides a snack only, children bring food from home and is placed in a refrigerator for the child care. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Hanging window blind cords: the cords are hung up and inaccessible to children. Pets: there are no pets on premises. Phone service: there is a working landline and cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does not provide transportation for children.

Knives are kept in the kitchen in a drawer secured with a safety tab, inaccessible to children in care. Medication is kept in the off-limits bedroom, inaccessible to children in care. Cleaning supplies and chemicals are kept under the sink with a safety tab, inaccessible to children in care.

There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, adhesive tape, and cleansing pads/solution was observed to be complete and inaccessible to children kept in the bathroom under the sink secured with a safety tab. The required fire extinguisher (2A10BC) is reading in green, last tested on 8/13/2023. The smoke and carbon monoxide detectors were tested and found to be in operable condition at 2:54pm and 2:53pm, respectively. The State Fire Marshall approved the manual fire pull and the single-action door lever to the entry/exitway.

Licensee does not have insurance on the family child care home and has the parents complete the LIC 282-Affidavit Regarding Liability Insurance for Family Child Care Homes.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARUSINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197414315
VISIT DATE: 12/13/2023
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Licensee was able to provide the required documents for the Assistant: a valid CPR/First Aid training valid until 9/2025. Child Care Provider Mandated Reporter Training Certificate has been completed and valid until 11/2025. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Training, Immunizations: MMR, Tdap, TB, & Flu shots, and background clearances.

LPA discussed the required children’s records: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, school enrollment forms, and PM 286-California School Immunization Record.

Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative 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.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARUSINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197414315
VISIT DATE: 12/13/2023
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LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed the Facility Representative 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. Provided Licensee with an Infant Sleep Plan form LIC 9227 and the sleep log.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

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/.

Facility Representative 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.

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARUSINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197414315
VISIT DATE: 12/13/2023
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The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is in compliance, but not yet ready for the increase in capacity, the following correction must be completed prior to the approval of the increased capacity:

· Licensee will acquire additional bedding of 6 additional mats/cots to meet capacity requirements

Once the Licensee has provided proof that the above correction has been completed, the capacity increase will be approved. The Licensee states they will e-mail the proof no later than 12/27/2023.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Facility Representative.

All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
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