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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401908
Report Date: 02/12/2020
Date Signed: 02/12/2020 04:31:03 PM

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:JAYASINGHE FAMILY DAY CAREFACILITY NUMBER:
197401908
ADMINISTRATOR:JAYASINGHE, ARUNIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 832-5051
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:12CENSUS: 11DATE:
02/12/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Aruni JayasingheTIME COMPLETED:
02:45 PM
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Margarit Sislyan, Licensing Program Analyst (LPA) arrived at the facility to observe the corrections of the deficiencies cited on 12/17/2019.

LPA reviewed children’s files and observed all forms that is required by Title 22 were in the file.
The citation was cleared.

Exit interview
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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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