<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416911
Report Date: 07/29/2021
Date Signed: 07/29/2021 03:12:02 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:KOTUWELLE FAMILY CHILD CAREFACILITY NUMBER:
197416911
ADMINISTRATOR:KOTUWELLE/ VINDYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 212-8886
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:14CENSUS: 7DATE:
07/29/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Vindya KotuwelleTIME COMPLETED:
03:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 07/29/2021 at 2:42pm Licensing Program Analyst (LPA) Laticia Thompson conducted a case management to follow up on an Unusual Incident Report, reported on 06/22/2021. LPA was greeted by Vindya Kotuwelle (licensee) and Ruwan Kotuwelle (husbandj).

LPA observed 6 children, one infant and one assistant Elia Gila. LPA observed bedroom area which is off limits located across from the bathroom. Bedroom was locked and being supervised by husband. In the bedroom LPA observed a construction worker assisting husband. LPA did not observe construction worker to be in area of which care was being provided to children. The bedroom is currently under construction, repairs are being made to the floor. LPA did not visually observed any dangerous machinery or dangerous material accessible to children.

Licensee will notify department when repairs have been completed. Licensee also agreed to provide pictures upon completion of construction work.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1