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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019180
Report Date: 06/22/2023
Date Signed: 06/22/2023 05:02:55 PM

Document Has Been Signed on 06/22/2023 05:02 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SUBASINGHE FAMILY CHILD CAREFACILITY NUMBER:
198019180
ADMINISTRATOR:KALYANI SUBASINGHEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 316-6185
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Kalyani Subasinghe, LicenseeTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced case management visit on 06/22/23. LPA arrived at the facility at 3:45 PM and was met by Licensee, Kalyani Subasinghe. The purpose of this visit is to follow up on the unusual incident report dated 06/13/23. LPA observed the facility to be clean and in good repair.

During the inspection, LPA interviewed the licensee regarding the unusual incident. LPA also reviewed child's file and reviewed the children's roster.

LPA observed facility to be in compliance with California Code of Regulation, Title 22. No deficiencies will be cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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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