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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019180
Report Date: 10/29/2024
Date Signed: 10/29/2024 04:40:37 PM

Document Has Been Signed on 10/29/2024 04:40 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SUBASINGHE FAMILY CHILD CAREFACILITY NUMBER:
198019180
ADMINISTRATOR/
DIRECTOR:
KALYANI SUBASINGHEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 316-6185
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Licensee, Kalyani SubasingheTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jonnisha Culbert attempted to performed an unannounced Annual Random Inspection at the facility noted above. LPA met with licensee Kalyani Subasinghe stated the purpose of today’s visit, and provided her with an entrance checklist for family childcare homes (LIC126). Licensee guided LPA on a tour of the facility of both indoor and outdoor. Individuals residing in the home were discussed and noted. Present at the time of inspection were licensee, adult 1, staff 1, and four children in care. Per licensee, hours of operation are Monday through Friday 6am to 5pm.

All areas accessible to children were inspected and children files were reviewed.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Due to time restraints the Annual/Random visit will be completed on a future date. LPA will address deficiencies observed on this date at a future visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Kalyani Subasinghe.

Valarie CookTELEPHONE: (323) 513-3858
Jonnisha CulbertTELEPHONE: (323) 246-2016
DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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