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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101126
Report Date: 11/22/2022
Date Signed: 11/22/2022 09:28:27 AM

Document Has Been Signed on 11/22/2022 09:28 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERATH, SAMADHI FAMILY CHILD CAREFACILITY NUMBER:
376101126
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
11/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Samadhi HerathTIME COMPLETED:
09:40 AM
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Licensing Program Analyst, (LPA), Tyra Block, conducted an unannounced inspection for a capacity increase with the licensee, Samadhi Herath accompanied by her husband, Kumudu Herath. This visit is to verify that the licensee remains in substantial compliance with the health & safety standards as required by regulations governing family child care homes. LPA met with licensee, also present were 4 children in care. Licensee has all appropriate forms posted. First Aid/CPR and mandated reporter certifications are current. LPA confirmed with licensee that all adults residing/working in the home have criminal record and TB clearances. The single story house was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. LPA observed the pull station and fire alarm. Fire clearance was received on 11/8/22. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Licensee states that there are no weapons in the home. Licensee has provided landlord notification and understands landlord consent is required to care for more than 12 and up to 14 children. The home appears to comfortably accommodate 14 children.

Licensee will be using the following rooms for childcare: child care area, and small hall bathroom. The following areas will be off limits: all bedrooms, kitchen, and dining area. Age-appropriate toys and equipment are available for children to use and the home has a fenced backyard available for outdoor activities.

The following information was reviewed with the licensee: information on reporting requirements for suspected child abuse and unusual incidents, children’s records/ forms and posting requirements, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, Safe Sleep Regulation/SIDS. Licensee was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERATH, SAMADHI FAMILY CHILD CARE
FACILITY NUMBER: 376101126
VISIT DATE: 11/22/2022
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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.

Licensee was reminded Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. Licensee was encouraged to visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to subscribe to receive email communication

Licensee is also advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for forms and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided: (714) 703-2800 or [email protected].



MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN
4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN
KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.


No deficiencies are cited. No corrections are needed; a license for 14 will be issued effective today.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
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