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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624013
Report Date: 06/01/2022
Date Signed: 06/01/2022 03:15:56 PM

Document Has Been Signed on 06/01/2022 03:15 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:EPA AMARASEKERA, WIDANA GAMAGEFACILITY NUMBER:
343624013
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/01/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Widana Gamage Epa AmarasekeraTIME COMPLETED:
11:00 AM
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LPA Pascual met with Licensee on June 1st, 2022 for the purpose of an announced capacity increase. Upon arrival there were four children with the licensee. LPA toured the house and viewed the exit signs, the hard-lined alarm system and fire extinguisher that the fire department had the licensee install and/or relocate prior to receiving clearance.

LPA reviewed the fire clearance to verify approval as well. The home was ready for the capacity increase.

Effective today: June 1st, 2022 this home is now licensed for A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met with an assistant present)

(a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.

(b) No more than three infants are cared for during any time when more than 12 children are being cared for.

(c) The licensee notifies a parent that the facility is caring for two additional school age children and that there may be up to 13 or 14 children in the home at one time.

An exit interview was conducted & a Notice of Site visit was presented for posting.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2022
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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