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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018763
Report Date: 05/29/2024
Date Signed: 05/29/2024 03:51:15 PM

Document Has Been Signed on 05/29/2024 03:51 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DE SILVA FAMILY CHILD CAREFACILITY NUMBER:
198018763
ADMINISTRATOR/
DIRECTOR:		HEWA KOSGODAGE DE SILVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 331-4221
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
05/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:HEWA KOSGODAGE DE SILVA / LICENSEETIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPAs) Ashley Calderon conducted an unannounced random annual inspection and met with Licensee Hewa De Silva. LPAs disclosed the purpose of the inspection and was granted entry into the facility by Licensee.

LPA toured with licensee facility inside and outside, and no hazards were observed. LPA observed fire extinguisher serviced and charged dated 6/28/23, inspections are done annually.

Required postage were observed and posted in living room area.

Due to time constraint LPA Calderon will return at a later time.

Exit interview was conducted with Licensee.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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