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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400678
Report Date: 10/16/2023
Date Signed: 10/16/2023 12:49:18 PM

Document Has Been Signed on 10/16/2023 12:49 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GAMARALALAGE FAMILY CHILD CAREFACILITY NUMBER:
198400678
ADMINISTRATOR:CHANDRIKA GAMARALALAGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 325-6208
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
10/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Licensee Chandrika Gamaralalage TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Jeanette Estrada and Angelica Wallin conducted an unannounced Case Management inspection at the facility listed above. LPAs met with Licensee.
LPAs observed three children and one additional adult (Adult 1) providing care and supervision present during the inspection.
During the visit LPAs reviewed the Facility Personnel Report. Adult 1 appears on the report as "pending". LPAs reviewed documentation in staff file which stated Adult 1's DOJ clearance was rejected on 8/8/23 and Adult 1 is required to re-do the fingerprint clearance. Per Licensee, Adult #1 has been working in the facility for approximately one month. Adult #1 left the facility at 12:23PM. Licensee was advised Adult #1 cannot return to provide care and supervision until criminal record clearance is complete.
A type A citation is being issued today regarding the criminal record clearance violation and a $500 maximum civil penalty was assessed.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Licensee, Chandrika Gamaralalage.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2023
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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Document Has Been Signed on 10/16/2023 12:49 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 10/16/2023 at 11:34 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GAMARALALAGE FAMILY CHILD CARE
FACILITY NUMBER: 198400678

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/17/2023
Section Cited
CCR
102370(d)(1)

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102370(d)(1)All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility:Obtain a California clearance...required by the Department. This requirement is not met as evidenced by:
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Licensee was advised that DOJ notice in staff file states that Adult #1's fingerprints were rejected on 8/8/23 and they must be re-fingerprinted. LPAs observed Adult #1 leave the facility at 12:23PM. Per Licensee, Adult #1 will obtain a fingerprint clearance on 10/17/23.
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Licensee did not ensure that Adult #1 had a completed criminal record clearance. Adult #1 was observed providing care and supervision to children per Licensee adult 1has been at the facility for one month. This poses an immediate risk to the safety of children in care.
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Licensee was advised that Adult #1 cannot return to provide care and supervision until criminal record clearance is completed.

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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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2023


LIC809 (FAS) - (06/04)
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