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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700301
Report Date: 09/17/2025
Date Signed: 09/17/2025 12:20:26 PM

Document Has Been Signed on 09/17/2025 12:20 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: 4DATE:
09/17/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:03 AM
MET WITH:GAYESHA WICKRAMARACHCHIGETIME VISIT/
INSPECTION COMPLETED:
12:33 PM
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On 09/17/2025, Licensing Program Analyst (LPA) Ana Rodriguez conducted an inspection at WICKRAMARACHCHIGE Family Child Care. The purpose of the inspection was a Plan of Correction visit to review the Type A deficiency that was cited on 8/1/25 for Title 22 of the California Code of Regulations and/or Health & Safety codes: 102417 (g)(5) and ensure that the licensee has made the body of water/fish pond inaccessible to daycare children by surrounding the body of water/fish pond with a fence. LPA met with Licensee GAYESHA WICKRAMARACHCHIGE and toured the facility. During todays inspection LPA observed Licensee providing active care to 1 infant and 4 preschool children. All adults in the facility have a Criminal Record Clearance (DOJ/FBI) and Child Abuse Index Clearance and are associated to the facility.

The following was observed: During the visit LPA Rodriguez observed the body of water/fish pond in the backyard (right side of home). The wrought iron fence is constructed at least five (5) feet high and is secured directly to the concrete and dirt surfaces. 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. LPA tested the gate and observed the following: gate swings away from the fish pond, it self-closes, and self-latches with a device no more than six (6) inches from the top of the gate and a key locking mechanism is installed for added security. LPA confirmed that all climbable objects have been removed and placed away from the fence. The fence is bolted to the right side of the home and to the right concrete wall surrounding the perimeter of back yard. Back yard is no longer off limits. Right side of the home with the fish pond is off limits. LPA obtained photographs.

No deficiencies are being cited at this time. A Plan of Correction letter was provided to licensee.

An exit interview was conducted, and a copy of this report was read and provided to licensee, along with a copy of licensee's Notice of Site Visit. Notice of Site Visit (LIC 9213) must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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.

LIC809 (FAS) - (09/23)
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