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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700301
Report Date: 08/01/2025
Date Signed: 10/02/2025 04:19:54 PM

Document Has Been Signed on 10/02/2025 04:19 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WICKRAMARACHCHIGE FAMILY CHILD CAREFACILITY NUMBER:
367700301
ADMINISTRATOR/
DIRECTOR:		GAYESHAWICKRAMARACHCHIGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 877-6976
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/01/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee, Gayesha Wickramarach ChigeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 10/02/2025 LIcensing Program Analyst Ana Rodriguez amended facility evaluation report dated 8/1/2025 for the purpose to correct the information provided concerning the requirements for bodies of water.
On 8/1/2025 at 9:30 a.m., Licensing Program Analysts (LPA) Ana Rodriguez conducted an unannounced annual inspection at Wickramarach Family Child Care. Upon arrival, LPA was greeted by the licensee, Gayesha Wickramarach, who provided a facility tour. The home is occupied by 2 adults (the licensee and her husband) and 1 minor child. Seven childcare children were present during the inspection. The licensee stated that the facility operates from 5:00 AM-8:00 PM Monday through Friday. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children currently require IMS.
The home is set up as follows:
This is a two-story house with 3 bedrooms, 2 bathrooms, flex room, loft, a living room, a dining area, kitchen, a laundry room, and a garage. Body of water is located on the right of the home in the backyard. The home was inspected for safety, comfort, cleanliness, telephone service, and ventilation. It has central heating and air conditioning, and all windows have screens free of cracks, bugs, and debris.
Main Area: The living room and flex room are for childcare. Children can access bathroom #1.
Living Room: LPA observed age-appropriate toys and furniture in the designated childcare areas. There is child-size furniture and several plastic storage bins containing games and toys for the children. The facility also has games and books available. Mats with educational and learning activities are on the floor and were noted to be in good condition. Two adult-size couches are present, and a TV is used to play educational videos for the children.
Flex room: The flex room is used for napping. LPA observed 1 playpen, 3 cribs, and 4 cots. Children will nap under adult supervision in designated area. The licensee does not provide overnight care.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2025
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.

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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WICKRAMARACHCHIGE FAMILY CHILD CARE
FACILITY NUMBER: 367700301
VISIT DATE: 08/01/2025
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Children's Bathroom (#1): The children’s bathroom is opon entry to the home to the right. LPA observed that the toilet and faucets are clean and operable. The medication cabinet is free of medications or personal items. The bathroom was found to be clear of any hazardous items.

Off-limit: The front yard, entire upstairs (barricaded by safety gate), backyard, laundry room and garage(key lock door knob) are inaccessible to the daycare children.

Kitchen: The kitchen was inspected for safety, and it was noted that hazardous items are kept out of children's reach with child safety latches. Poisons, and medications are not accessible to children. Sharp knives and utensils are stored in the pantry made inaccessible to children with safety latch.Backyard: The backyard was inspected. Licensee stated that the backyard will be temporarily made off-limits and inaccessible to daycare children until the fish pond located in the backyard is fully fence and complies with regulations. LPA obtained signed LIC855-Declaration from Licensee. Fish pond is approximately 9 feet wide by 18 feet long and 1 1/2 feet deep. It is sorounded by rocks and contains 6 fish The backyard is gated all around. LPA observed a grass and concrete area. LPA provided PIN 25-01-CCP.

Additional Information:


Bodies of water: LPA observed an in-ground fish pond in the backyard. It is missing the following requirements: The Mesh/ Chain link/wood/lattice/wrought iron fences constructed at least five (5) feet high. The bottom of the fence is no more than two (2) inches from the ground. The fence does not obscure the fish pond from view. Gates must swing away from the body of water, self-close, and have a self-latching device no more than six (6) inches from the top of the gate. The licensee understands and agrees that the fencing will remain in place whenever licensed care is provided, so long as the fence makes the fish pond inaccessible to children, as determined by licensing staff. No items around the perimeter of the fence would allow the fence to be climbable.
An AC/Heating unit is located on the left side of the home and is inaccessible to children. All unused electrical outlets are plugged and inaccessible to children. The licensee provide breakfast, lunch, and snacks. A required fire extinguisher (2A10BC) was observed to be mounted on the wall near bathroom #1. It is reading in the green zone, inaccessible to children, and meets standards established by the State Fire Marshal. If a child shows signs of illness, they will be separated from other children and stay in flex room. Detergents and cleaning compounds are stored in an off limits garage.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WICKRAMARACHCHIGE FAMILY CHILD CARE
FACILITY NUMBER: 367700301
VISIT DATE: 08/01/2025
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The household has two small dogs (kept in the garage), all of which have current vaccinations. The home has a working cell phone. All smoke detectors and carbon monoxide devices were tested and found to be operable. A fully stocked first aid kit, including a first aid manual, and is inaccessible to children. The licensee does not provide transportation for the children. Weapons or Firearms: Per the licensee, there are no weapons or firearms at the facility. LPA did not observe any weapons or firearms.
Documentation Review:
Child Files: LPA reviewed 3 children's records. The files contain all necessary licensing documents with parents’ signatures.Infant Sleeping Plan (LIC 9227) and Sleeping Log: 1 infant has LIC 9227 forms, and their sleeping logs were in place by the Safe Sleep Regulation.
Staff Personnel File: During the inspection, LPA reviewed 2 staff file, which included LIC 508, LIC 9052, immunization records, LIC 9108, and CPR/First Aid certificates. TB test missing for 2 assistats. Mandated reporter missing for 1 assistant.
Immunization Records: The licensee and her assistants have up-to-date immunizations for MMR and DTaP, and all have submitted written statements declining the influenza vaccine.
CPR/First Aid: LPA verified that the licensee and her assistants hold current Pediatric CPR and First Aid certifications.
Mandated Reporter Training: The licensee and her assistant completed the online mandated reporter training at www.mandatedreporterca.com, 1 assistant missing mandated reporter training.
Fire/Disaster Drill: The licensee conducts fire and disaster drills every six months, with the last drill documented on 3/5/25
Required Postings: LPA observed that the licensee does have the Facility License, Emergency Disaster Plan, Earthquake Preparedness, and Parents' Rights Poster displayed as required.
The following information was discussed with the licensee:
-A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
-The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
-Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WICKRAMARACHCHIGE FAMILY CHILD CARE
FACILITY NUMBER: 367700301
VISIT DATE: 08/01/2025
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 The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
-Requirements for fire drills, earthquake drills, and documentation for both.
-The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
-The licensee is reminded that 100% supervision is always required for children.
-The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, contact the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
-The regulation prohibits tobacco smoking in private residences that are licensed as family childcare homes and in those areas of the family childcare home where children are present (24/7 ban).
-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-and- resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
-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, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/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.
-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/.
-Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WICKRAMARACHCHIGE FAMILY CHILD CARE
FACILITY NUMBER: 367700301
VISIT DATE: 08/01/2025
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-Family Child Care Homes During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
-Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.
-To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. 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 regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-carelicensing/ inspection-process.

Deficiencies cited: (See LIC 809D). The following Type A deficiencies is being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes: 102417 (g)(5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
An immediate civil penalty of $500 was assessed.

An exit interview was conducted, and the report was reviewed with the licensee Gayesha Wickramarach.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/02/2025 04:22 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/02/2025 03:27 PM


Created By: Ana Rodriguez On 08/01/2025 at 01:48 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WICKRAMARACHCHIGE FAMILY CHILD CARE
FACILITY NUMBER: 367700301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, LPA observed a fish pond in the backyard of the home, it is not made inaccessible to the day care children, the depth is approxiamtely 1.5 feet, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2025
Plan of Correction
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Licensee stated on a LIC855- Declaration that the backyard will be off-limits until the fish pond can be made inaccessible to daycare children. Fence will be in place by 8/04/25. Licensee stated that sliding doors leading to the backyard will remain locked at all times while day care children are present.
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.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Ana Rodriguez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2025


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