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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842842
Report Date: 03/27/2023
Date Signed: 03/27/2023 08:49:15 AM


Document Has Been Signed on 03/27/2023 08:49 AM - 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:DE SILVA FAMILY CHILD CAREFACILITY NUMBER:
334842842
ADMINISTRATOR:DE SILVA, CHAMALIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 583-3077
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:14CENSUS: 4DATE:
03/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Belinda Stewart & Miriam GranadoTIME COMPLETED:
09:00 AM
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
Licensing Program Analysts (LPAs) James Wilkerson and William Chancellor arrived at this facility to conduct a case management visit. Present during this visit were assistants Belinda Stewart and Miriam Granado. Licensee, Chamali De Silva and her spouse were not present. There are four children present at this time. Ms. Stewart stated that the licensee is out because she has some medical appointments. The off limit areas are inaccessible at this time.

An exit interview was conducted, appeal rights discussed and provided along with a Notice of Site Visit and a copy of this report to Ms. Stewart.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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