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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
334840727
Report Date:
02/18/2020
Date Signed:
05/25/2022 10:07:39 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
05/25/2022 10:07 AM
- 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
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
JAYASINGHE FAMILY CHILD CARE
FACILITY NUMBER:
334840727
ADMINISTRATOR:
JAYASINGHE, RANJANI
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(951) 746-3256
CITY:
MENIFEE
STATE:
CA
ZIP CODE:
92584
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
02/18/2020
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME BEGAN:
08:00 AM
MET WITH:
Renuka Jayasinghe-Licensee
TIME COMPLETED:
09:00 AM
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This report was generated in error and should have been recorded under facility 334844706. This report will remain blank as the correct report was conducted on 2/25/2020 under the correct facility
.
SUPERVISORS NAME
:
Dawn Parker
LICENSING EVALUATOR NAME
:
Lakesha Edwards
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/25/2020
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/18/2020
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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