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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410494
Report Date: 09/04/2024
Date Signed: 09/04/2024 01:01:45 PM


Document Has Been Signed on 09/04/2024 01:01 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:JAYASINGHE, PRIYANTHIFACILITY NUMBER:
434410494
ADMINISTRATOR:JAYASINGHE, PRIYANTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 245-6026
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Priyanthi JayasingheTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Mel Matos met with Priyanthi Jayasinghe, Licensee, for an unannounced Required - 3 Year inspection. LPA was granted access to the home by the Licensee. Licensee states that she has not had any children enrolled in the day care since March 2020. Licensee states that she is planning on reopening her day care by Spring/Summer 2025 and wishes to place her license on "Inactive" status at this time.

LPA discussed the Request for Inactive Child Care License Status (LIC 9211) form with Licensee and Licensee provided a completed/signed copy of the Request for Inactive Child Care License Status (LIC 9211) form to LPA prior to the completion of today's inspection.

Licensee understands that she must contact the Department prior to reopening her day care for a follow up inspection.

Licensee agreed to submit an updated Application for a Family Child Care Home (LIC 279) and Emergency Disaster Plan (LIC 610A) to LPA Matos by Friday September 20, 2024.

Exit interview conducted and report was reviewed with the Licensee, Priyanthi Jayasinghe. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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