Kid's Happy Days Child Care

This Statement of Deficiencies was generated as a result of the on-site State licensure inspection conducted at your facility on 03.04.2026. Please respond to each deficiency and attach documents as requested for the deficiency it pertains to. Sign and submit your Plan of Correction within 10 business days of receipt. Inspection consensus, the facility is licensed for 6 children as a Family Care facility. The census at the time of survey was 1 child. No children's files and no staff files were reviewed. Basedon observation and interview, the facility was found to have hazards as listedbelow. Several hazards were observed in the outdoor play area during the semiannual inspection including: 1. The brown empty shelf to left of the sliding door (facing away from the home) needs to be relocated to an area inaccessible to children. Surveyor observed a screw exposed, corner of the shelf coming off with sharp edges and splinter hazard due to rough wood exposed. Per provider, she was using the shelf to block the area where a cord is plugged for the sprinkler system. As discussed during the inspection

The facility is licensed for 6 children as a Family Care. The census at the time of inspection was 2 children. 3 child's file and 4 staff files were reviewed. Annual Hours: Please submit all annual hours to surveyor by 9/15/2025 via email. - Sudarshini W.: Needs 2 hours of wellness and an additional 22 annual training hours. - Shantha W.: Needs 2 hours of wellness and an If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: SUDARSHINI Title: provider Date: 10/2 Based on observation, the following hazards were observed: - The water hose in the back yard are stored on holder loosely, accessible to children, and pose as a potential choking hazard. Water hose will need to be stored neatly and tighten on holder or removed from back yard. Please correct and upload pictures. - The white cabinet on back yard patio has AND PLAN OF Based on observation, the following hazards were observed: - The bathroom wall around light switch and light switch were observed with heavy dark stains. The wall and light switch will need to be cleaned. Please correct and upload pictures. - The facility will need to implement a child safety gate in the hallway of the home or install child locks on the bedroom doors to ensure children are unable to access the home when using the restroom. Please correct and upload pictures. - The facility will need to install child locks on kitchen cabinets and drawers to ensure children do not have access t Based on file review, Sudarshini W. and Shantha W. Nevada Registry Certificate Expired on 5/30/2025. Renew Nevada Registry and upload updated certificates to provide proof of these corrections. NAC 323 1. Except as otherwise provided in NAC NAC 323 1. Submit Shantha's training classes 432A.521 and NRS 432A.177, within 120 2. On September17,2025 days after commencing his or her 3. I will ensure all documents up to date employment or position in a child care 4. As a provider it is my responsibility facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person i... Based on file review, the following staff are missing initial trainings: Sudarshini- Needs one hour of Human Growth and Development or Positive Guidance Training. During file review, staff only had two certificates in file dated for 11/16/2023. Shantha- Needs three hours of Human Growth and Development or Positive Guidance Training. During file review, staff had no certificates for this requirement in file for review. Upload Human Growth and Development or Positive Guidance training certificate for review. FORM APPR Based on observation and file review, the facility does not have written toilet training guidelines posted within facility, within the Parent Handbook, or Child Enrollment Packet. Written toilet training guidelines will need to be developed and distributed to parents. Complete written toilet training guidelines and upload. When developing the facility's written toilet guideline ensure to utilize code NAC 432A. 413 to ensure your facility guideline includes required information. Division of Public and Based on observation the child gate to block off the children's access to the kitchen and remainder of the home was observed not in use. The child gate will need to be in use at all times during hours of operation to ensure the kitchen and remainder of the home are inaccessible to children. Please note that this hazard was also listed on SNHD's 5/20/2025 inspection report as a violation due to being observed propped open. NAC NAC 1. Drinking water freely available to all 380.10 10. Drinking water must be freely available 380.10 children to all children at all times. 2. On September 17, 2025 3 Based on observation drinking water was not accessible to children in childcare room. Children had no water cups or bottles in classroom labeled with their name. Ensure that drinking water is freely available to all children at all times. NAC 385 1. The staff of each facility shall: NAC 385 1. * Labeled each bottle of formula and (a) Provide appropriate and adequate food containers each child's name and prep seating for the children at the facility during date snacks and meals; * Cleaned the highchair (b) If a high chair is used, ensure that the * Labeled baby feeding bottles chair: 2. On Sep Based on observation, the high chair tray was observed with stains and debris. The highchair tray will need to be cleaned and sanitized. Please make corrections and upload pictures. Furthermore, infant child's bottle of milk was not labeled with name and date. The second child’s food was not labeled by name and date. Ensure that all formula, breast milk, milk, and food are labeled with name and date as required. NAC 430 1. Each facility, including, without limitation, NAC 430 1. Attached the written plan of curriculum a family home and a group home, shall 2. On September 17,2025 have an early Based on observation, the facility failed to maintain up to date curriculum/ lesson plan. The facility's curriculum/ lesson plan was not posted for parental view. Upload an updated curriculum/ lesson plan for the month of August. Ensure the lesson plan Integrate age appropriate key areas of instruction, including, without limitation, literacy, mathematics, science, social studies, creative expression and the arts, and health and safety. NAC 416 1. Each member of the staff of a facility that NAC 416 1. I provide rest mat for 3 year old child is necessary to meet the applicable and I will let children either play with requirement for the ratio of caregivers to puzzles, color in coloring books, or read a children set forth in Based on observation, a 3-year-old child was observed sleeping in a pack n play. Provider was informed that 3-year- old children need to be placed to sleep mat or cot for naps. It should be noted that during the Semi-Annual Inspection, provider was written out for this deficiency. Moving forward, provider will need to utilize age appropriate sleeping devices for nap time. Furthermore, a child was observed not sleep in pack n play. The provider failed to removed child from the pack n play after 15 minutes. If child is not sleep following 15 minutes, child must be removed from crib/ pack n play

The facility is licensed for 6children as a Center. The census at the time of inspection was 3 children. 0 child's files and 0 staff files were reviewed. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE Based on observation and interview, Owner reported that she has an 18 -year-old live-in daughter, Maneesha Wijekularatne that was present at the time of inspection, and 24- year-old son, Chamuda Wijekularatne who is frequently in the home and was present at the time of inspection. Surveyor did not see Chamuda, however, Owner did report that he was in the home utilizing the restroom. Maneesha Wijekularatne and Chamuda Wijekularatne will need to complete new Consent & Release form and fingerprints. Divisi Based on observation, the following hazards were observed on facility’s playground during facility’s playground: - The playground has five wire gardening towers along the back of the yard that will need to be placed behind the gate to be inaccessible to children. Make corrections and upload pictures to provide proof of this correction. - The wooden child table begins to bulk and splint. Child table will need to be discarded and/or replaced. Make corrections and upload pictures to provide proof of this correction. - During backyard walkthrough, Surveyor Bradley was poked through shoe by burwee Based on interview, it was discovered that the owner’s adult children Maneesha and Chamuda do not have a TB test on file. Maneesha and Chamuda will need to complete TB test and upload results to provide proof of this correction. NAC 416 1. Each member of the staff of a facility that NAC 416 1. I will send pictures surveyor Ms Bradley 05/12/202 is necessary to meet the applicable today 5 requirement for the ratio of caregivers to 2. On May 12 2025 children set forth in Based on observation, at the time of arrival a 3-year-oldchild and 4-year-old child were observed in pack n plays for nap time with toys and infant bottles of milk. It should be noted that the owner was informed of age- appropriate sleeping devices, surveyor 970 B. WING _________

The facility is licensed for 6 children as a Family Care. The census at the time of investigation was 2 children. 2 children's files and 2 staff files were reviewed. Reminders: Submit Renewal application and upload If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE STATEMENT OF DEFICIENCIE Based on record review and interview, NABS roster is inaccurate and need to term Chamuda W and upload Sudarshini signed and stamped Consent and Release form into NABS as currently expired. Upload current NABS roster. 970 B. WING _______________________ 09/03/2024 Based on record review and interview, Sudarshini and Shantha need negative TB test results. Upload current TB tests for both then place in employee file. NRS 230 NRS 230 1. Attached Alexander Arce's updated shot Certificate of immunization prerequisite to records admission to child care facility; conditional 2. September 30,2024 admission; report to Health Division. Except 3. I will ensure that keep all children's shot as otherwise provided in NRS 432A.235 for records are up to date accommodation facilities: 4. As a provider it is my responsibility 1. Except as otherwise provided in subsectio Based on record review, Child #2 needs updated immunizations. Upload current shot record then place in child file.

The facility is licensed for 6 children as a Family Care. The census at the time of investigation was 2 children. 3 children's files and 2 staff files were reviewed. Reminder: Term Chamuda W from NABS since no longer living in home. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 09/14/2023. The facility is licensed for 6 children as a family care. The census at the time of survey was 3 children. 5 children's files and 3 staff files were reviewed. Reminder: Please upload all required renewal documents to renewal application If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATU Based on observation, interview and record review, the facility ' s fire extinguisher was not tagged to show a current date of inspection and maintenance. Please make the necessary contact for inspection and maintenance. 970 B. WING _______________________ 09/14/2023 NAME OF PROV Based on record review and interview, the facility did not have a health statement signed by a registered nurse or physician within 30 days after admission. Please upload proof of health statement for children listed on the identifier list. Child # 2 Child # 5 NRS 230 NRS 230 1. I submitted current immunizations Certificate of immunization prerequisite to records. I will ensure all children's records admission to child care facility; conditional are up to date. admission; report to Health Division. Except 2. On October 03, 2023. as otherwise provided in NRS 432A.235 for 3. I will ensure all c Based on record review and interview, the facility admitted children who were not up to date with immunizations or for whom no record was present or needed an updated. Please upload updated immunizations for children listed on the identifier list. Child # 2 NAC 430 1. Each facility, including, without limitation, NAC 430 1. I attached children's assessments. I will a family home and a group home, shall ensure all children's records are up to date. have an early care and education program. 2. On September 20, 2023. 2. Each facility described in subsection 1 3. I will ensure all children's reco Based on observation, interview and review of records, the facility did not assess each child within three months after enrollment in the facility or repeat assessment every six months. Please upload assessments for children listed on the identifier list. Child # 1 Child # 2

The facility is licensed for 6 children as a Family Care. The census at the time of inspection was 0 children. 4 children's files and 2 staff files were reviewed. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE

The facility is licensed for 6 children as a Family Care. The census at the time of inspection was 1 child. 3 children's file and 2 staff files were reviewed. **Only 3 child files could be reviewed as only 3 children are currently enrolled at the facility.** Reminder: Submit remainder of Sudarshini's annual hours to S. Burdon by 9/30/22: 18 hrs due. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE

License capacity 6 Facility Type FC Total Number of Children 1 Number of child files reviewed 1 Number of staff files reviewed 3 NAC 310 1. Every member of the staff of a facility, NAC 310 1. I submitted Chamuda Wijekularatne's x- 04/06/202 including a volunteer, and each resident of ray result for T B 2 the facility shall present to the director of 2. On April 6,2022 the facility, to be placed in the person’s file, 3. I will keep all records up to date written evidence that the person is free from 4. As a provider, it is my responsibility communicable tuberculosis. The evidence If deficienci Based on record review the Providers son's TB test has expired.

REMINDERS 1) Provider need 7 additional hours of annual training 2 hours must include wellness/childhood obesity. Please upload all 24 hour of training under #16 in your renewal application. Failure to complete annual training by 9/30/21 may result in a $100.00 fine. 2) All diaper creams and over the counter medication must have a medication authorization signed by the parent 3) Please remember to practice different disaster drills such as Active Shooter, Earth quake, Wind Storm etc. 4) Complete and upload all policies and procedures and upload into the renewal application If deficiencies are Based on record review the child in attendance was missing the general admission form. 970 B. WING _______________________ 09/22/2021 KID'S HAPPY DAYS CHILD CARE 6201 W. OAKEY BLVD, LAS VEGAS, NEVADA ,89146 (X4) S Based on record review the child in attendance needs updated shots.

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 04/01/2021. NAC 306 1. Every caregiver in a child care facility NAC 306 1. Sudarshini Wijekularatne and Shantha must: Wijekularatne renewed their NEVADA (a) Be at least 16 years of age; REGISTRY registration (b) Be able to summon help in an 2. May 04, 2021 ( certificates e-mail to child emergency; care licensing surveyor). (c) Be emotionally and physically qualified 3. It will not happen in the future. to carry out a program which places 4. As a provider, it is my respo Based on interview and record review, the facility failed to ensure that within 90 days of hire each employee had a completed application or renewal of Nevada Registry membership. Owner and Alternate

The facility is licensed for 6 children as a Family Care. The census at the time of inspection was 2 children. 3 child's file and 4 staff files were reviewed. Annual Hours: Please submit all annual hours to surveyor by 9/15/2025 via email. - Sudarshini W.: Needs 2 hours of wellness and an additional 22 annual training hours. - Shantha W.: Needs 2 hours of wellness and an If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: SUDARSHINI Title: provider Date: 10/2 Based on observation, the following hazards were observed: - The water hose in the back yard are stored on holder loosely, accessible to children, and pose as a potential choking hazard. Water hose will need to be stored neatly and tighten on holder or removed from back yard. Please correct and upload pictures. - The white cabinet on back yard patio has AND PLAN OF Based on observation, the following hazards were observed: - The bathroom wall around light switch and light switch were observed with heavy dark stains. The wall and light switch will need to be cleaned. Please correct and upload pictures. - The facility will need to implement a child safety gate in the hallway of the home or install child locks on the bedroom doors to ensure children are unable to access the home when using the restroom. Please correct and upload pictures. - The facility will need to install child locks on kitchen cabinets and drawers to ensure children do not have access t Based on file review, Sudarshini W. and Shantha W. Nevada Registry Certificate Expired on 5/30/2025. Renew Nevada Registry and upload updated certificates to provide proof of these corrections. NAC 323 1. Except as otherwise provided in NAC NAC 323 1. Submit Shantha's training classes 432A.521 and NRS 432A.177, within 120 2. On September17,2025 days after commencing his or her 3. I will ensure all documents up to date employment or position in a child care 4. As a provider it is my responsibility facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person i... Based on file review, the following staff are missing initial trainings: Sudarshini- Needs one hour of Human Growth and Development or Positive Guidance Training. During file review, staff only had two certificates in file dated for 11/16/2023. Shantha- Needs three hours of Human Growth and Development or Positive Guidance Training. During file review, staff had no certificates for this requirement in file for review. Upload Human Growth and Development or Positive Guidance training certificate for review. FORM APPR Based on observation and file review, the facility does not have written toilet training guidelines posted within facility, within the Parent Handbook, or Child Enrollment Packet. Written toilet training guidelines will need to be developed and distributed to parents. Complete written toilet training guidelines and upload. When developing the facility's written toilet guideline ensure to utilize code NAC 432A. 413 to ensure your facility guideline includes required information. Division of Public and Based on observation the child gate to block off the children's access to the kitchen and remainder of the home was observed not in use. The child gate will need to be in use at all times during hours of operation to ensure the kitchen and remainder of the home are inaccessible to children. Please note that this hazard was also listed on SNHD's 5/20/2025 inspection report as a violation due to being observed propped open. NAC NAC 1. Drinking water freely available to all 380.10 10. Drinking water must be freely available 380.10 children to all children at all times. 2. On September 17, 2025 3 Based on observation drinking water was not accessible to children in childcare room. Children had no water cups or bottles in classroom labeled with their name. Ensure that drinking water is freely available to all children at all times. NAC 385 1. The staff of each facility shall: NAC 385 1. * Labeled each bottle of formula and (a) Provide appropriate and adequate food containers each child's name and prep seating for the children at the facility during date snacks and meals; * Cleaned the highchair (b) If a high chair is used, ensure that the * Labeled baby feeding bottles chair: 2. On Sep Based on observation, the high chair tray was observed with stains and debris. The highchair tray will need to be cleaned and sanitized. Please make corrections and upload pictures. Furthermore, infant child's bottle of milk was not labeled with name and date. The second child’s food was not labeled by name and date. Ensure that all formula, breast milk, milk, and food are labeled with name and date as required. NAC 430 1. Each facility, including, without limitation, NAC 430 1. Attached the written plan of curriculum a family home and a group home, shall 2. On September 17,2025 have an early Based on observation, the facility failed to maintain up to date curriculum/ lesson plan. The facility's curriculum/ lesson plan was not posted for parental view. Upload an updated curriculum/ lesson plan for the month of August. Ensure the lesson plan Integrate age appropriate key areas of instruction, including, without limitation, literacy, mathematics, science, social studies, creative expression and the arts, and health and safety. NAC 416 1. Each member of the staff of a facility that NAC 416 1. I provide rest mat for 3 year old child is necessary to meet the applicable and I will let children either play with requirement for the ratio of caregivers to puzzles, color in coloring books, or read a children set forth in Based on observation, a 3-year-old child was observed sleeping in a pack n play. Provider was informed that 3-year- old children need to be placed to sleep mat or cot for naps. It should be noted that during the Semi-Annual Inspection, provider was written out for this deficiency. Moving forward, provider will need to utilize age appropriate sleeping devices for nap time. Furthermore, a child was observed not sleep in pack n play. The provider failed to removed child from the pack n play after 15 minutes. If child is not sleep following 15 minutes, child must be removed from crib/ pack n play

The facility is licensed for 6children as a Center. The census at the time of inspection was 3 children. 0 child's files and 0 staff files were reviewed. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE Based on observation and interview, Owner reported that she has an 18 -year-old live-in daughter, Maneesha Wijekularatne that was present at the time of inspection, and 24- year-old son, Chamuda Wijekularatne who is frequently in the home and was present at the time of inspection. Surveyor did not see Chamuda, however, Owner did report that he was in the home utilizing the restroom. Maneesha Wijekularatne and Chamuda Wijekularatne will need to complete new Consent & Release form and fingerprints. Divisi Based on observation, the following hazards were observed on facility’s playground during facility’s playground: - The playground has five wire gardening towers along the back of the yard that will need to be placed behind the gate to be inaccessible to children. Make corrections and upload pictures to provide proof of this correction. - The wooden child table begins to bulk and splint. Child table will need to be discarded and/or replaced. Make corrections and upload pictures to provide proof of this correction. - During backyard walkthrough, Surveyor Bradley was poked through shoe by burwee Based on interview, it was discovered that the owner’s adult children Maneesha and Chamuda do not have a TB test on file. Maneesha and Chamuda will need to complete TB test and upload results to provide proof of this correction. NAC 416 1. Each member of the staff of a facility that NAC 416 1. I will send pictures surveyor Ms Bradley 05/12/202 is necessary to meet the applicable today 5 requirement for the ratio of caregivers to 2. On May 12 2025 children set forth in Based on observation, at the time of arrival a 3-year-oldchild and 4-year-old child were observed in pack n plays for nap time with toys and infant bottles of milk. It should be noted that the owner was informed of age- appropriate sleeping devices, surveyor 970 B. WING _________

The facility is licensed for 6 children as a Family Care. The census at the time of investigation was 2 children. 2 children's files and 2 staff files were reviewed. Reminders: Submit Renewal application and upload If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE STATEMENT OF DEFICIENCIE Based on record review and interview, NABS roster is inaccurate and need to term Chamuda W and upload Sudarshini signed and stamped Consent and Release form into NABS as currently expired. Upload current NABS roster. 970 B. WING _______________________ 09/03/2024 Based on record review and interview, Sudarshini and Shantha need negative TB test results. Upload current TB tests for both then place in employee file. NRS 230 NRS 230 1. Attached Alexander Arce's updated shot Certificate of immunization prerequisite to records admission to child care facility; conditional 2. September 30,2024 admission; report to Health Division. Except 3. I will ensure that keep all children's shot as otherwise provided in NRS 432A.235 for records are up to date accommodation facilities: 4. As a provider it is my responsibility 1. Except as otherwise provided in subsectio Based on record review, Child #2 needs updated immunizations. Upload current shot record then place in child file.

The facility is licensed for 6 children as a Family Care. The census at the time of investigation was 2 children. 3 children's files and 2 staff files were reviewed. Reminder: Term Chamuda W from NABS since no longer living in home. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE

This Statement of Deficiencies was generated as a result of the on-site State licensure survey conducted at your facility on 09/14/2023. The facility is licensed for 6 children as a family care. The census at the time of survey was 3 children. 5 children's files and 3 staff files were reviewed. Reminder: Please upload all required renewal documents to renewal application If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATU Based on observation, interview and record review, the facility ' s fire extinguisher was not tagged to show a current date of inspection and maintenance. Please make the necessary contact for inspection and maintenance. 970 B. WING _______________________ 09/14/2023 NAME OF PROV Based on record review and interview, the facility did not have a health statement signed by a registered nurse or physician within 30 days after admission. Please upload proof of health statement for children listed on the identifier list. Child # 2 Child # 5 NRS 230 NRS 230 1. I submitted current immunizations Certificate of immunization prerequisite to records. I will ensure all children's records admission to child care facility; conditional are up to date. admission; report to Health Division. Except 2. On October 03, 2023. as otherwise provided in NRS 432A.235 for 3. I will ensure all c Based on record review and interview, the facility admitted children who were not up to date with immunizations or for whom no record was present or needed an updated. Please upload updated immunizations for children listed on the identifier list. Child # 2 NAC 430 1. Each facility, including, without limitation, NAC 430 1. I attached children's assessments. I will a family home and a group home, shall ensure all children's records are up to date. have an early care and education program. 2. On September 20, 2023. 2. Each facility described in subsection 1 3. I will ensure all children's reco Based on observation, interview and review of records, the facility did not assess each child within three months after enrollment in the facility or repeat assessment every six months. Please upload assessments for children listed on the identifier list. Child # 1 Child # 2

The facility is licensed for 6 children as a Family Care. The census at the time of inspection was 0 children. 4 children's files and 2 staff files were reviewed. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE

The facility is licensed for 6 children as a Family Care. The census at the time of inspection was 1 child. 3 children's file and 2 staff files were reviewed. **Only 3 child files could be reviewed as only 3 children are currently enrolled at the facility.** Reminder: Submit remainder of Sudarshini's annual hours to S. Burdon by 9/30/22: 18 hrs due. If deficiencies are cited, an approved plan of correction must be returned within 10 days after receipt of this statement of deficiencies. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER Name: Title: Date: REPRESENTATIVE'S SIGNATURE

License capacity 6 Facility Type FC Total Number of Children 1 Number of child files reviewed 1 Number of staff files reviewed 3 NAC 310 1. Every member of the staff of a facility, NAC 310 1. I submitted Chamuda Wijekularatne's x- 04/06/202 including a volunteer, and each resident of ray result for T B 2 the facility shall present to the director of 2. On April 6,2022 the facility, to be placed in the person’s file, 3. I will keep all records up to date written evidence that the person is free from 4. As a provider, it is my responsibility communicable tuberculosis. The evidence If deficienci Based on record review the Providers son's TB test has expired.