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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419095
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:19:16 PM

Document Has Been Signed on 05/25/2023 01:19 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WEERASINGHE FAMILY CHILD CAREFACILITY NUMBER:
197419095
ADMINISTRATOR:WEERASINGHE, LAKSHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 267-7848
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Sandhaya Weerasinghe and Hasitha WeerasingheTIME COMPLETED:
01:33 PM
NARRATIVE
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Sandhaya Weerasinghe, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a 2 story 3 bedroom, 3 bathroom home with kitchen, living room, backyard and garage. There is no pool on the premises. Upon arrival LPA observed 5 children with licensee Sandhaya Weerasinghe. Licensee Hasitha Weerasinghe later arrived to the home to assist with the visit.

Physical Plant: Main care is provided in the living room. Children use the bathroom near the homes front door. Children have access to the living room, children's bathroom and backyard. Off limit areas include all of the homes upstairs area, kitchen, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under the sink), medicines (inaccessible in top kitchen cabinet) and hazardous items (sharp knives inaccessible on top of the kitchen cabinet) that can pose a danger to children. There is no fireplace in the home. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and fire extinguisher (2A10BC) are in operable condition. Per Licensee Sandhaya no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment were observed on the premises. There is a designated area for ill children as necessary in living room. Per Licensee Sandhaya there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 04/28/23. Roster complete and maintained current.

Bathroom: LPA Dorsey observed the homes children's bathroom is free of hazards (child care bathroom). The children's bathroom toilet and faucet are clean and operable.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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Document Has Been Signed on 05/25/2023 01:19 PM - It Cannot Be Edited


Created By: Justin Dorsey On 05/25/2023 at 12:50 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WEERASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197419095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/16/2023
Plan of Correction
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Per licensee Hasistha, both himself and Licensee Sandhaya will complete the Pediatric First Aid/CPR Training and provide LPA Dorsey with a copy of the certificates by POC due date 06/16/23
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:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WEERASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197419095
VISIT DATE: 05/25/2023
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Kitchen: Sharp utensils are inaccessible. Per licensee Sandhaya children enrolled at the home bring their own food. LPA Dorsey observed the the children's lunch boxes were labeled with the children's name. Cleaning supplies are locked under the sink. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has turf, and a concrete area under a plastic play house for children to play. Per licensees the right side of the backyard which has concrete and a gazebo is off limits to children in care. Per licensees when the children are outside a chair is placed in this area to barricade children from going to that area. LPA observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. During the visit LPA Dorsey observed the licensees CPR/First Aid certifications expired 12/2020 and their Mandated Reporter Training Certificates expired 10/2020. LPA Dorsey advised the licensee to complete both the CPR/First Aid Training and the Mandated Reporter Training and retake every 2 years. Children nap on cots and cribs in the living room.

Documents discussed: LIC 9227 and Safe Sleep PIN 20-24-CCP.

Licensees were 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.

LPA discussed the safe sleep regulations with licensees 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 licensees 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WEERASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197419095
VISIT DATE: 05/25/2023
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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 Hasitha Weerasinghe .

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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