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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842357
Report Date: 05/19/2023
Date Signed: 05/19/2023 12:19:53 PM

Document Has Been Signed on 05/19/2023 12:19 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:AMARATUNGA FAMILY CHILD CAREFACILITY NUMBER:
334842357
ADMINISTRATOR:AMARATUNGA, RALPH/JUNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 614-4345
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:TIME COMPLETED:
12:24 PM
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Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conduct a Case Management inspection in response to the receipt of an Unusual Incident Report (UIR) from the facility dated
April 13, 2023. It documents an incident involving Child #1 who fell while playing outside and sustained an injury. There were two staff present when the incident occurred. Appropriate supervision and care was being provided. The facility notified the Authorized Representative immediately after the incident occurred.

At the time of the inspection, LPA toured the facility, took census, and met with Ralph Amaratunga, Licensee. Additional interviews with pertinent parties were conducted to obtain details regarding the reported incident. During the facility tour the area in which the incident occurred was observed.

Child #1 was taken to seek medical care later in the evening on the day of the incident and was diagnosed with a fracture on the right leg. Child #1 returned to care on April 24, 2023 and was monitored by facility staff.

Based on the information gathered, the incident was an accident as facility staff followed care and supervision protocols. Authorized Representative was immediately notified of the incident and Licensing was notified in a timely manner. Child #1 continues to attend the facility. Facility acted appropriately and was found to be in substantial compliance during this inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Ralph Amaratunga.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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