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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817209
Report Date: 06/08/2023
Date Signed: 06/08/2023 02:25:59 PM

Document Has Been Signed on 06/08/2023 02:25 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
PALMDALE CHILD CARE, 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: 14CENSUS: 10DATE:
06/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:LicenseeTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA), Maddox met with licensee, WICKRAMASINGHE, NIMAL today for the purpose of conducting and unannounced Annual/Random inspection. Present today were 5 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 around day care children. Licensee states she only cares for children ages 3 to 6 years.
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. The entire yard is fenced. All unused electrical outlets are plugged and play equipment and toys
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WICKRAMASINGHE FAMILY CHILD CARE
FACILITY NUMBER: 364817209
VISIT DATE: 06/08/2023
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are available.
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. Licensee has current CPR and First Aid (exp 7/2024).
All adults 18 years and older living in the home or visiting for extended periods of time should have criminal background clearances with the Department of Justice and or associations, failure to comply will result in Civil Penalty assessments.

******Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 o 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: http://www/ada.gov/childqanda.htm

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.
Exit interview conducted, a copy of this report and LIC 811 left with licensee at the conclusion of this inspection.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
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