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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419095
Report Date: 02/10/2023
Date Signed: 02/10/2023 02:46:05 PM


Document Has Been Signed on 02/10/2023 02:46 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: 6DATE:
02/10/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Hasitha WeerasingheTIME COMPLETED:
03:00 PM
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On 02/10/23 Licensing Program Analyst (LPA) Justin Dorsey conducted an inspection at Weerasinghe FCC. The purpose of the inspection was a Plan of Correction visit to review the deficiency cited on 02/07/23. LPA met with Licensee Hasitha Weerasinghe and toured the facility.

The following was observed:
1.) During the visit LPA Dorsey observed the home was in ratio with 6 children (3 infants & 3 preschoolers). Per licensee 2 children were disenrolled so the home can remain in ratio. LPA Dorsey reminded the licensee to send LPA a copy of the proposed children's weekly schedule by POC due date 02/13/23

Exit interview conducted a copy of this report, and Notice of Site Inspection was left with Hasitha Weerasinghe.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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