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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417035
Report Date: 01/26/2024
Date Signed: 01/26/2024 10:00:38 AM

Document Has Been Signed on 01/26/2024 10:00 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ATURUGIRIGE FAMILY CHILD CAREFACILITY NUMBER:
197417035
ADMINISTRATOR:ATURUGIRIGE, INDRANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 367-6543
CITY:SANTA CLARITASTATE: CAZIP CODE:
91390
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
01/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee TIME COMPLETED:
11:00 AM
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On January 26, 2024, Licensing Program Analyst (LPA) Andrew Alemoh conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone and or email on 01/19/2024; this incident was reported timely. LPA spoke with licensee. LPA toured the facility and took a census of the children. Upon arrival, there were 1 children w/ the licensee providing care and supervison.

Description of the incident: An incident on 01/19/2024, licensee called to notify the department that a child #1 was having a hard time breathing due to a sickness of mucus and phlegm build up.

LPA interviewed licensee, obtained a copy of children's files, and obtained a copy of the facility roster.

It was revealed that paramedics arrived at the day care home to check up on child #1 health. Statements revealed that child #1 was not transported to the hospital due to paramedics’ statements stating that the child is fine. Parents were notified by the licensee. No citations are being issued on this date. This Unusual Incident was reported timely to the Palmdale Regional Office.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ATURUGIRIGE FAMILY CHILD CARE
FACILITY NUMBER: 197417035
VISIT DATE: 01/26/2024
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An exit interview was conducted, and a copy of this report was provided to the licensee along with Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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