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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419095
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:01:37 PM

Document Has Been Signed on 02/07/2023 03:01 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WEERASINGHE FAMILY CHILD CAREFACILITY NUMBER:
197419095
ADMINISTRATOR:WEERASINGHE, LAKSHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 267-7848
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
02/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Hasitha WeerasingheTIME COMPLETED:
03:15 PM
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On 02/07/23 Licensing Program Analyst (LPA) Justin Dorsey, met with Licensee, Hasith Weerasinghe for a Case Management - Deficiencies. Upon arrival LPA Dorsey observed 13 children with the licensee and assistant #1.

During the inspection the following was observed:
ยท Upon arrival to the home LPA Dorsey observed the home was out of ratio with 13 children present (5 infants, 7 preschoolers and 1 school age).

LPA Dorsey read Licensee the report and gave a copy of the LIC 809, Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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 2
Document Has Been Signed on 02/07/2023 03:01 PM - It Cannot Be Edited


Created By: Justin Dorsey On 02/07/2023 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WEERASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 197419095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/08/2023
Section Cited
CCR
102416.5

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102416.5 Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children... when there is an assistant provider in the home, (1) ...no more than four of whom may be infants (2) More than twelve and up to fourteen children only if..This requirement is not met as evidenced by:
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Per licensee he will ensure the home is in ratio and always have less than 4 infants present in the home by POC due date 02/08/23. Per licensee he will also provide LPA Dorsey a schedule of when children will be present in the home by POC due date 02/13/23
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Based on observation LPA Dorsey observed 13 children, 5 which were infants present in the home, which poses a potential Health, Safety or Personal Rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


LIC809 (FAS) - (06/04)
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