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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817209
Report Date: 07/12/2021
Date Signed: 07/15/2021 09:01:04 AM

Document Has Been Signed on 07/15/2021 09:01 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WICKRAMASINGHE FAMILY CHILD CAREFACILITY NUMBER:
364817209
ADMINISTRATOR:WICKRAMASINGHE, N & SFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 883-9982
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:WICKRAMASINGHE, NIMALTIME COMPLETED:
01:28 PM
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Licensing Program Analyst (LPA), Maddox met with licensee, WICKRAMASINGHE, NIMAL today for the purpose of conducting and unannounced Required 1 yr inspection. Present today were 8 day care children and licensee. The home is a single story family home which has been converted from a 3 bedroom 2 bath to a 1 bedroom and 3 bathrooms (2 bathrooms have 2 toilets and 1 sink in each). Licensee states they converted 2 bedrooms to open space for the day care (during this inspection, this open area was set up as a living room). Licensee has also converted the garage to an activity area for children where children are free to perform (sing, dance, etc.). **There are no pools, spas or any other bodies of water on the premises. All adults in the home, licensee and husband only have fingerprint clearances and exams for T.B. Licensee has a total of 6 small dogs in the home, she states she has rescued and have current vaccines. LPA observed children wearing face mask and a hand sanitizing area upon entrance to the home.

The kitchen and bathrooms were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children (locked cabinet). The entire yard is fenced.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WICKRAMASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 364817209
VISIT DATE: 07/12/2021
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 All unused electrical outlets are plugged and play equipment and toys
are available. Licensee has current CPR and First Aid training (exp 1/2022). Per licensee, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devise are in operable condition. Licensee keeps a current Roster and record of Disaster drills

The licensee is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

LPA reviewed a sampling of children's files, files were complete and contained emergency contact information and other required documents.

There were no violations noted as a result of this unannounced inspection. Exit interview conducted, a copy of this report and LIC 811 left with licensee at the conclusion of this inspection.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
LIC809 (FAS) - (06/04)
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