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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850217
Report Date: 08/16/2024
Date Signed: 08/16/2024 06:33:04 PM


Document Has Been Signed on 08/16/2024 06:33 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:WE CARE SENIOR FACILITY LLCFACILITY NUMBER:
565850217
ADMINISTRATOR:HORDAGODA, SHASHIKAFACILITY TYPE:
740
ADDRESS:3350 EL NIDO STTELEPHONE:
(818) 571-1905
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 1DATE:
08/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:43 PM
MET WITH:Shashika HordagodaTIME COMPLETED:
06:40 PM
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Licensing Program Analysts (LPAs) Kelly Dulek and Teresa Camara conducted a Case Management - Other visit to the facility for the purpose of issuing Immediate Exclusion orders. LPAs arrived at the facility at 04:43PM and initially met with facility staff. Licensee/Administrator was contacted via telephone and arrived shortly after the visit began. LPAs explained the reason for today's visit. Entrance interview conducted.

Order of Licensee/Facility of Immediate Exclusion from Facility was issued by the LPAs in reference to facility staff Malith Mendis. LPAs Dulek and Camara issued the Order to Licensee/Administrator Shashika Hordagoda. The Order regarding Exclusion from Facility indicates that Malith Mendis is not allowed to have contact with clients and is not allowed to be physically present at the facility. The Order regarding Individual Exclusion indicates that Malith Mendis is not allowed to have contact with clients or to be present at any facility licensed by the California Department of Social Services.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2024
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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