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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370175
Report Date: 06/14/2021
Date Signed: 06/17/2021 03:01:05 PM

Document Has Been Signed on 06/17/2021 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LA HABRA HERITAGE SCHOOLFACILITY NUMBER:
304370175
ADMINISTRATOR:WIJEGUNARATNE, DEEPIKAFACILITY TYPE:
830
ADDRESS:323 NORTH EUCLID STREETTELEPHONE:
(562) 691-1967
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
06/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Director - Depika WijegunaratneTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Corral contacted Director Deepika Wijegunaratne in response to an Amended Report dated on 05/24/2021. The COVID-19 Emergency Response questionnaire was reviewed and answered by Director.

Original Findings of Complaint Investigation were delivered via Tele-Inspection on 05/24/2021. Reason for Tele-Inspection on 06/14/2021 was to inform Licensee of Amended Report dated on 05/24/2021. Director was informed the original report dated on 05/24/2021 was amended to be changed from Confidential to Public. Licensee was informed that a copy of the Amended Report would be emailed to her.

Exit interview was conducted and report was read to Director Deepika Wijegunaratne. A copy of the Report along with Appeal Rights will be email to Director with a Read Receipt requested to acknowledge report was received. Director was asked to respond to email by copying and pasting “I have read and received the Report and Appeal Rights, I acknowledge receipt." Appeal Rights were explained. Licensee was informed first level of appeal is directed to Regional Manager to the address listed above. Notice of Site Visit was not posted due to Tele-Investigation.

End of Report.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Eileen Corral
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
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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