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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400678
Report Date: 02/07/2024
Date Signed: 02/07/2024 11:58:44 AM

Document Has Been Signed on 02/07/2024 11:58 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GAMARALALAGE FAMILY CHILD CAREFACILITY NUMBER:
198400678
ADMINISTRATOR:CHANDRIKA GAMARALALAGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 325-6208
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 5DATE:
02/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Licensee Chandrika Gamaralalage TIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced Case Management inspection at the facility listed above. The purpose of this inspection was to inform Licensee of a deficiency being cited as a result of information obtained during a complaint investigation reported to the Department on 10/12/23.
LPA met with Licensee who provided a tour of the facility. LPA observed five children and two adults providing care and supervision present during the inspection.
During the complaint investigation it was revealed that regulations for infant safe sleep were not being followed properly. Per regulation 102425(j)(4) The provider shall be near enough to the sleeping infant to be able to hear them wake up. Based on interviews, the Licensee and Adult 1 were in the front part of the home, in the kitchen and the living room while Child 1 was in the back of the home in the infant nap room when the incident reported in the complaint occurred. The Licensee reported hearing Child 1 cry when she entered the infant nap room. A type A citation is being issued today regarding infant safe sleep. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC 9099D.
The notice of site visit was posted where the parent/guardian of children enter and exit the facility.
A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.
Licensee was advised that a copy of this report will be provided to the Resource and Referral Agency per an agreement between CDSS and the R&R network.
Exit interview conducted and a copy of this report and appeal rights were given to Licensee, Chandrika Gamaralalage.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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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Document Has Been Signed on 02/07/2024 11:58 AM - It Cannot Be Edited


Created By: Jeanette Estrada On 02/07/2024 at 10:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GAMARALALAGE FAMILY CHILD CARE
FACILITY NUMBER: 198400678

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2024
Section Cited
CCR
102425(j)(4)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (4)The provider shall be near enough to the sleeping infant to be able to hear them wake up.
This requirement was not met as evidenced by:
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Per Licensee, Assistant provider will stay in the infant nap room when infants are present. Assistant provider will sign in and out of nap room and a log will be kept. Licensee will provide proof of sign in/out sheet for 2/7/24 and 2/8/24 to LPA.
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Based on interviews,Licensee did not hear Child 1 cry when the incident on 10/11/23 occurred until she entered the room. Licensee was in the kitchen at the front of the home and Child 1 was in the in the back of the home which poses an immediate risk to the personal rights to children in care.
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 Licensee will provide a declaration with plan of supervision in case Assistant provider is not present.

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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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2024


LIC809 (FAS) - (06/04)
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