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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314575
Report Date: 07/02/2026
Date Signed: 07/02/2026 11:40:22 AM

Document Has Been Signed on 07/02/2026 11:40 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:DASANAYAKA, WASANTHIFACILITY NUMBER:
304314575
ADMINISTRATOR/
DIRECTOR:		DASANAYAKA, WASANTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 855-0018
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 1CENSUS: 0DATE:
07/02/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Dasanayaka, Wasanthi (Licensee) TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 07/02/2026, an unannounced Annual/Random inspection and an additional day care children's restroom were conducted at the facility by Licensing Program Analyst (LPA) V. Trinh. LPA observed the licensee caring for a total of zero (0) children. The licensee stated that the total enrollment is one (1) child, that children are on a staggered schedule and arrive at different times throughout the day, and that they are aware they cannot exceed the capacity ratio of 14 children at any one time. The facility was operating within the licensed capacity as specified on the license.

CRIMINAL RECORD CLEARANCE: A review of the Facility Personnel Report Summary on this date 07/02/2026 indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, there are 3 adults, including the licensee and one (1) minor child, living in the facility. Facility day-care hours are Monday through Sunday, 6:30 AM- 6:30 PM.

During today’s indoor inspection. The LPA inspected the indoor FCCH (Family Child Care Home) area identified in the Facility Sketch LIC999, as well as areas accessible to children. Off-limits areas were inaccessible to children in care, with child proof gates, and doorknobs in place at the time of inspection. The facility is a single-story home with 4 bedrooms, 2 bathrooms, a living room, a family room, a kitchen, a front yard (not fenced), a backyard (fenced), and a garage. There is a fireplace located in the family room, barricaded by a metal screen. The childcare area is accessed through the main door and consists of the family room, playroom, and backyard.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DASANAYAKA, WASANTHI
FACILITY NUMBER: 304314575
VISIT DATE: 07/02/2026
NARRATIVE
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INDOOR INSPECTION: The childcare area consists of the childcare room, accessible through the front door. The children use the restroom adjacent to childcare room #1 and another children’s restroom on the right-hand side of the hallway. The primary childcare is the living room, family room, and room #1. Licensee designated the entire area for rooms 2, 3, and 4, the kitchen, the front yard (no fence), part of the side backyard, storages, and the garage as off-limits areas.

ON-SITE FOOD PREPARATION: The facility does provide breakfast, lunch, and snacks to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. Filtered drinking water is available to children in care. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were clean and in good repair.

OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the outdoor activity area was well maintained and free of any observable hazards. Children will be able to have outside play in the enclosed backyard. There were no bodies of water or pets in the facility at the time of inspection.

Garage will not be used for day care. The Licensee stated the garage will be off-limits.

There are working carbon monoxide and smoke detectors that should be type 2A-10BC, and fire extinguishers in the home that meet statutory and State Fire Marshal standards. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available to children were stored in an inaccessible location to children. There were no poisons or other items observed that could pose a danger to children; if any were observed, they were locked or inaccessible. The license states there are no firearms or other dangerous weapons in the facility, and none were observed during today's inspections. The license stated that there are dangerous firearms in the facility. LPA observed that it is locked and stored separately from the ammunition.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DASANAYAKA, WASANTHI
FACILITY NUMBER: 304314575
VISIT DATE: 07/02/2026
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There is a fireplace and/or an open-faced heater in the living room, screened by a glass cover. or a metal mesh covering, which is barricaded by a cemented wall, and is inaccessible to children in care. The home has a central air and heating system, and the A/C unit is in the side yard, with a fencing barrier across it, making it inaccessible to children. The home has age-appropriate toys for the ages served.

The Licensee is aware that each FCCH shall conduct fire drills and disaster drills at least once every six months. Based on observation, interview, and record review, during the facility inspection, LPA requested to see the fire and disaster drill log. The licensee stated that they had not conducted any emergency drills with the children in care for the last 6 months. LPA verified there is a working telephone service (cellular service). Licensee was reminded that the childcare phone needs to remain in the childcare at all times. Licensee stated they use the backyard for outdoor play.

The licensee does have a current roster of children in care, with one (1) child record for children present during the LPA inspection. Children’s records for children present during the LPA inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700), Immunization records, Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parents’ Rights (LIC995A), and found to comply. The licensee stated that there is one (1) infant under 24 months enrolled in the childcare.

The licensee's Pediatric CPR/First Aid certification expired on 4/2027. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states that a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis and measles for the licensee and the assistant was reviewed and found to comply.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training and renew it every 2 years. During staff file review, the licensee’s mandated reporter certificate expired in 07/2027. Continued page 4.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DASANAYAKA, WASANTHI
FACILITY NUMBER: 304314575
VISIT DATE: 07/02/2026
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

The licensee understands that she must be present in the facility and ensure that children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise the children during the absence. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

The CCLD website (www.cdss.ca.gov/inforesources/community-care-licensing) was provided to the licensee to access regulations, updates, and licensing forms. The Licensee was advised to register via childcareadvocatesprogram@dss.ca.gov to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was provided to the licensee and explained.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed the licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended that they register all infant devices with the CPSC to be notified of any recalls for their purchased equipment. Continued page 5.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DASANAYAKA, WASANTHI
FACILITY NUMBER: 304314575
VISIT DATE: 07/02/2026
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Licensee was informed about the MyChildCarePlan.org website, a consumer education site that helps families access child care by connecting them with child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

In the areas evaluated, no deficiencies were observed in the California Code of Regulations, Title 22, Division 12, at the time of the visit. A technical violation was also given for CCR 102417(g)(9)(A) Operation of a Family Child Care Home.

The facility was not in compliance, and violations of the California Code of Regulations, Title 22, Division 12, were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22, Division 12, were observed and cited today: Operation of a Family Child Care Home 102417 (g)(9)(A), (see LIC 809D).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 per day, for a maximum of 5 days, or, if the penalty is for a repeat violation, for a maximum of 30 days per person, will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the provided email address. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information about the inspection, its tools, and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the Licensee, Dasanayaka, Wasanthi, confirmed that there are no Registered Sex Offenders living in the facility, and the LPA completed the RSO profile in FAS. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights.

A notice of site visit was given and must remain posted for 30 days.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 07/02/2026 11:40 AM - It Cannot Be Edited


Created By: Vivian Trinh On 07/02/2026 at 11:06 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: DASANAYAKA, WASANTHI
FACILITY NUMBER: 304314575

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review. The licensee did not comply with the section cited above. LPA requested to see the fire and disaster drill log. The licensee stated that they had not conducted any emergency drills with the children in care for the last 6 months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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The licensee will practice the fire drill and email the documentation to the LPA by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2026


LIC809 (FAS) - (06/04)
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