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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313980
Report Date: 02/28/2022
Date Signed: 02/28/2022 11:44:40 AM

Document Has Been Signed on 02/28/2022 11:44 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEELARATNE, SUMUDUFACILITY NUMBER:
304313980
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Applicant Ms. Leelaratne, Sumudu TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) conducted a follow up Pre-licensing inspection to ensure the home has met the licensing requirements per title 22. On the initial inspection conducted on February 10th 2022, Applicant needed to complete few corrections in the back yard fencing surrounding the Hot spa tub. (Bodies of water)

On today's inspection, LPA observed the Bodies of water (Hot spa tub) present on the premises was completed covered with locked sides where a key is needed to open the locks, it is not easily climbable. The entire covered patio area has been fenced and secured, so the children cannot go beyond the covered area as the surrounding back yard and side yards are inaccessible to children. Fencing surrounding the play area under the shaded patio has three opening and each of them have been secured with a zip tie making the play area safe for activities.
Applicant has set up the covered patio area for outdoor activities with several outdoor toys, concrete flooring has been covered with a green mat.

Spiked rose bush at the entrance of the home, has been cleared.

Areas Designated for Day care activities: Applicant has designated the living room, one half bathroom, and part back yard (Covered patio area) for Day care activities.

The facility on today's Pre-licensing inspection is in compliance for a (Small Family Child Care Home) with Title 22 Regulations. License shall be issued upon Management approval .



Exit interview conducted and report was reviewed with the applicant Ms. Leelaratne, Sumudu.

Appeal rights were presented to the applicant.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2022
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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