198019383-6-8-2021-33-CC-NTCG-C3SNSZ-20210608104358

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019383
Report Date: 06/08/2021
Date Signed: 06/08/2021 10:44:08 AM

Document Has Been Signed on 06/08/2021 10:44 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	WARNAPURAGE, WATHUTHANTRIGE & CHANDRASENA FCCH		FACILITY NUMBER:	198019383
ADMINISTRATOR:	WARNAPURAGE WATHUTHANTRIGE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 641-8047
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91006
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	06/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Piyumi Warnapurage - Licensee		TIME COMPLETED:	10:50 AM

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	Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random inspection to the above facility. At 8:30am, LPA conducted a COVID Risk Assessment over the telephone prior to entering facility. Following phone call, LPA met with licensee, Piyumi Warnapurage, to whom the purpose of the inspection was announced. The licensee states that she currently has 7 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are Monday - Friday 7am-6pm. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, front living room, back living room, front yard and backyard (fenced). The children use the bathroom attached to the front living room. Per licensee, areas off limits to children and parents include: all bedrooms, back restroom, front yard, kitchen, and back portion of backyard, separated by fencing. The licensee provides food for children in care. The licensee states that 5 adults and 1 minor currently live in the home. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises. PHYSICAL PLANT At 8:35am, LPA was lead on a tour of the facility by the licensee. The tour began in the front living room. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. In the living room LPA observed an AC unit attached to the front window and the fireplaces and open face heaters are inaccessible to prevent access by children. At 8:37am, A fire extinguisher was observed by the front door. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/11/2021, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The children's restroom was adjacent to the front living room. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. REPORT CONTINUES PAGE 1 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WARNAPURAGE, WATHUTHANTRIGE & CHANDRASENA FCCH	FACILITY NUMBER: 198019383
	VISIT DATE: 06/08/2021

NARRATIVE

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At 8:40am, the tour continued into the kitchen and dining area. LPA observed four children seated at the dining area eating breakfast. There was one adult at the table with the children. In the kitchen, LPA observed cabinets under the sink to have a child lock. Per licensee, the sharp knives are kept behind the the child lock cabinet. Licensee opened each drawer and cabinet and kitchen for LPA to observe the contents.

The back living room is used for additional play space and for nap times. Present in the back living room were napping cots and a play yard. At 8:43am, smoke and carbon monoxide detectors present in the back living room were tested and are operable. At 8:45am, LPA toured the back yard outdoor area and observed a fence separating and making the back portion of the yard inaccessible to children. The outdoor back area was observed to be fenced. Per licensee, a cell phone is used for the facility and stays at the facility during operating hours. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:
The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired on 03/2021 and additional personnel's First Aid and CPR expired 04/2021. Per licensee, she is enrolled in the CPR and First Aid course this coming weekend. Licensee and other personnel have complete mandated reporter training that expires on 02/13/2022. The licensee and other adults in presence of children do have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed:

Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
There are no pets on the premises.
Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
Smoking is prohibited in a license family child care home.

REPORT CONTINUES PAGE 2 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WARNAPURAGE, WATHUTHANTRIGE & CHANDRASENA FCCH	FACILITY NUMBER: 198019383
	VISIT DATE: 06/08/2021

NARRATIVE

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Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the back living room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):
Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

LPA observed that a COVID-19 Technical Assistance call had been made on 05/21/2020. LPA observed health and safety practices being conducted at facility.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview was conducted with Piyumi Warnapurage, Licensee, at 10:35am including, but not limited to Provider Rights, Appeal Procedures, and the Agencies Consultative Role.
END OF REPORT 3 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC809 (FAS) - (06/04)

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