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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845810
Report Date: 10/31/2024
Date Signed: 10/31/2024 02:52:07 PM

Document Has Been Signed on 10/31/2024 02:52 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VITHANAGE FAMILY CHILD CAREFACILITY NUMBER:
364845810
ADMINISTRATOR/
DIRECTOR:		VITHANAGE, NALIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 244-4536
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/31/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:06 PM
MET WITH:Nalika Vithanage, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 10/31/2024 at 02:06 PM, Licensing Program Analysts (LPA) Claudia Caywood arrived at the facility to conduct a Case Management Deficiencies visit. Upon arrival, LPA was met by Licensee, Nalika Vithanage. LPA stated to the licensee the purpose of the visit. During the facility visit, LPA toured the facility (inside and outside), and took a census.

LPA stated to licensee she needed to continue from the annual inspection today due to the licensee stating that her adult son does in fact live in the home. Her son turned 18 earlier this year in April 2024. LPA clarified with licensee that her adult son should have been fingerprint cleared with 30 days of turning 18.

See LIC 809-D for cited deficiencies of the California Code of Regulations, Title 22. Div.12

Licensee was provided the Acknowledgment of Receipt of Licensing Reports (LIC 9224) form. Licensee understands a copy of this report and the LIC 9224 form shall be provided to parents/guardians of children currently enrolled and parents/guardians of children who are enrolled 12 months from the date of this report.

An exit interview was conducted, and report was reviewed with the licensee, Nalika Vithanage. A Notice of Site Visit was issued and is to be posted in a prominent location at the facility for the next 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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Document Has Been Signed on 10/31/2024 02:52 PM - It Cannot Be Edited


Created By: Claudia Caywood On 10/31/2024 at 02:21 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VITHANAGE FAMILY CHILD CARE
FACILITY NUMBER: 364845810

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/01/2024
Section Cited
CCR
102370(d)(1)

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102370 (d)(1) Criminal Record Clearance:d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record...required by the Department
This requirement is not met as evidenced by:
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Licensee agreed to have their adult son fingerprinted and receipt provided to the department by POC due date of 11/1/2024. They will email the receipt by COB 11/1/2024
to claudia.caywood@dss,ca.gov
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Based on LPA record review and interview, licensee stated their adult son did in fact live at the facility home since they turned 18 in April of 2024.
Civil Penalty was assessed on 10/31/2024
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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.
SUPERVISOR'S NAME:Gilbert Sena
LICENSING EVALUATOR NAME:Claudia Caywood
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
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