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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494575
Report Date: 04/22/2022
Date Signed: 04/22/2022 09:03:20 AM

Document Has Been Signed on 04/22/2022 09:03 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DEVONSHIRE INFANT CENTERFACILITY NUMBER:
197494575
ADMINISTRATOR:MERADITH GRABLEFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 16DATE:
04/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Marian Ranasinhe, Licensee TIME COMPLETED:
09:15 AM
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On 04/22/2022, 8:15am, Licensing Program Analyst (LPA) Denise Miranda conducted a Case Management - other for the purpose of delivery an amended report of Case Management dated on 03/30/2022– Deficiency page (LIC809-D). Upon arrival, LPA met with Ms. Ranasinhe, Licensee and discussed the purpose of the visit. LPA Miranda and Ms. Ranasinhe signed the amend report (LIC809-D).

There are 16 infants present and 5 facility staff.

An exit interview was conducted and a copy of this report, along with LIC809-D amend report, appeal rights and Notice of Site Visit was provided to Marian Ranasinhe, Licensee.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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