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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842842
Report Date: 06/01/2023
Date Signed: 06/01/2023 08:31:33 AM


Document Has Been Signed on 06/01/2023 08:31 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: 8DATE:
06/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Marianne GranadoTIME COMPLETED:
07:42 AM
NARRATIVE
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LPA James Wilkerson arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 05/22/23. At the time of visit, LPA discussed the reported incident with Licensee, Chamali De Silva over the phone and assistant Marianne Granado.
Based on the information obtained during the there appeared to be no violations of Title 22 Regulations pertaining to the reported incident, however there are eight children present with one staff making the facility out of ratio as there are two infants and zero school age children. The oldest child is four years old.

See LIC 809D for deficiency cited per Title 22 Regulations.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

An exit interview was held with Assistant, Marianne Granado. Appeal Rights discussed and provided along with form LIC 9224, a Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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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Document Has Been Signed on 06/01/2023 08:31 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 334842842

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/01/2023
Section Cited
CCR
102416.5(b)

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(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1) Four infants; or
(2) Six children, no more than three of whom may be infants; or (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.
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LIcensee agreed over the phone to submit in writing on how the facility will remain in compliance with ratio(s). Licensee was reminded that per California Health and Safety Code Section 1548(b), 1568.0822(b), 1569.49(b), 1596.99(b), or 1597.58(b, that there would be a $100.00
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whom may be infants; or (3) More than six and up to eight children, without an additional adult attendant, This requirement was not met as there is one staff with eight children, with the oldest child being 4 years old and there are infants present. The large child reverts to a small child care when only staff member is present.
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Civil Penalty per day for every day the plan of correction is late.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
LIC809 (FAS) - (06/04)
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