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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313549
Report Date: 02/21/2025
Date Signed: 02/21/2025 01:16:35 PM

Document Has Been Signed on 02/21/2025 01:16 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FERNANDO, RASIKA & FERNANDO, THARINDUFACILITY NUMBER:
304313549
ADMINISTRATOR/
DIRECTOR:		FERNANDO, RASIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 853-8420
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/21/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensees, Rasika and Tharindu FerandoTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 02/21/2025 Licensing Program Analyst (LPA) Dianna Valdez Santana made an unannounced visit to the facility for the purpose of a case management Non-compliance inspection. LPA was met by licensees, Rasika and Tharindu Fernando. who were explained the reason for today’s visit. The Licensees and LPA toured the facility inside and out. During today's inspection LPA observed the two licensees caring for 3 preschool-age children during today’s visit.A review of the Facility Personnel Report Summary conducted on 02/21/2025 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensees were reminded that all adults 18 and over, 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 Family Childcare 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.

During the tour of the facility LPA observed living/dining room to be free of clutter, LPA inspected the backyard, it was safe and free of hazards. LPA also reviewed Safe Sleep forms (Safe Sleep Log and Individual Sleeping Plan forms). LPA discussed the following regulations and the importance of staying within substantial compliance in accordance of Title 22: Admission Procedures and Parental and Authorized Representative's Rights, Operation of a Family Child Care Home, Personnel Records, Staffing Ratio and Capacity, Mandated Reporter Training, Immunizations, Staffing Ratio and Capacity, and Infant Safe Sleep. The licensees acknowledge the importance of the facility to maintain compliance with title 22 regulations and health & safety codes.

Based on today's visit and observations, there were not deficiencies observed today.
A copy of this report, along with the appeal rights and notice of site visit was provided to licensee, Rasika Fernando. Their signature on this report acknowledges receipt of these rights.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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