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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419095
Report Date: 11/18/2022
Date Signed: 11/18/2022 12:20:27 PM


Document Has Been Signed on 11/18/2022 12:20 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:WEERASINGHE FAMILY CHILD CAREFACILITY NUMBER:
197419095
ADMINISTRATOR:WEERASINGHE, LAKSHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 267-7848
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: DATE:
11/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:TIME COMPLETED:
12:35 PM
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On 11/18/22 Licensing Program Analysts (LPA's) Justin Dorsey and Joselito Del Mundo, met with Licensee, Hasitha Sandhaya for a Case Management - Other. Upon arrival LPA Dorsey observed 5 children with the licensee and assistant #1.

During the inspection the following was observed:
ยท LPA Dorsey observed 2 infants sleeping in cribs with blankets, pillows and bottles. LPA observed that the blankets were removed form the infants cribs by the licensee.
  • LPA Dorsey observed the home had a infant rocker in the home. LPA Dorsey advised licensee that the item shall not be used in the home by children in care. LPA Dorsey observed the rocker was placed in the garage.

LPA Dorsey issued Technical Violations and went over and gave a copy of Safe Sleep PIN 20-24-CCP, Infant Safe Sleep Log and LIC 9227 to the licensee Sandhaya. LPA Dorsey read Licensee the report and gave a copy of the LIC 809, Notice of Site Visit and Appeal Rights.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022
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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