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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019383
Report Date: 04/02/2025
Date Signed: 04/02/2025 03:28:24 PM

Document Has Been Signed on 04/02/2025 03:28 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WARNAPURAGE, WATHUTHANTRIGE & CHANDRASENA FCCHFACILITY NUMBER:
198019383
ADMINISTRATOR/
DIRECTOR:		WARNAPURAGE WATHUTHANTRIGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 641-8047
CITY:ARCADIASTATE: CAZIP CODE:
91006
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/02/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Piyumi Warnapurage - Co-licenseeTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Required 3-Yr inspection to the above facility. At 1:50am LPA met with co-licensee, Kanchana Chandrasena. Co-licensee Piyumi Warnapurage arrived soon after. 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 7am-6pm, Monday-Friday.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front room, front yard, detached garage, and backyard (fenced). The children use front room (classroom), bathroom in front, kitchen, dining room, living room (nap room), and backyard. Per licensee, areas off limits to children and parents include: front yard, detached garage, bedrooms, and additional bathroom.. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 6 adults and 0 minors currently live in the home. Persons living in home are identified on the attached LIC811. Licensee states that she currently has one assistant. 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.

At 8:45am, LPA was lead on a tour of the facility by the licensee. Upon entry into the home, the front room (children's classroom) was reviewed. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Next to the entrance door, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/11/2025, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. There were age appropriate toys and equipment present for children in care. Fireplaces and open face heaters are inaccessible to prevent access by children.


REPORT CONTINUES PAGE 1 of 3
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WARNAPURAGE, WATHUTHANTRIGE & CHANDRASENA FCCH
FACILITY NUMBER: 198019383
VISIT DATE: 04/02/2025
NARRATIVE
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LPA observed a play yard with child napping in it. Safe Sleep was reviewed. Per licensee, the front room will be used as an area for an ill child until an authorized representative comes to pick up child. The tour continued into the children's bathroom, which is directly accessible from the front room. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The tour continued through the kitchen. Kitchen is accessible to children. LPA observed that sharp knives and other equipment were made inaccessible via safety latch on cabinet handle. The dining area for children was adjacent to the kitchen.

The living room was reviewed next. There were 5 additional children napping. Play yards and cots are being used for napping equipment. LPA observed a bouncer in the living room and discussed with Licensee that it cannot be present in the child care facility. Licensee removed the bouncer from child care area. There are first aid supplies available. Smoke and carbon monoxide detectors were tested and are operable. Licensee states they have both landline and cellphone but the cellphone is used more often.The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock

At 2:20pm, LPAs observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There is a grass area with swing set, small slides, and carts to play with. At time of inspection, LPA observed an Additional Dwelling Unit (ADU) being constructed in the back part of the property plot. It was reported to the department and fencing has been made in order to keep children from accessing that area. LPA discussed with licensee the ADU's future in regards to residence and accessibility in backyard. The licensee is observed to be operating within the license capacity limitations.

At 2:45pm, facility records were reviewed. 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 expires on 06/2025. Co-licensees have completed mandated reporter training that 03/16/2026. The licensees 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.

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.


REPORT CONTINUES PAGE 2 of 3
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WARNAPURAGE, WATHUTHANTRIGE & CHANDRASENA FCCH
FACILITY NUMBER: 198019383
VISIT DATE: 04/02/2025
NARRATIVE
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The following was discussed:
-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, 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.

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.

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 maximum of 30 days per person will be assessed if regulation is violated

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-andresources/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 infant devices with the CPSC to be notified of recalls on purchased equipment.

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/.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Piyumi Warnapurage, at 3:40pm. Copy of report provided.


END OF REPORT
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5