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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573621640
Report Date: 02/27/2024
Date Signed: 02/27/2024 09:16:06 AM

Document Has Been Signed on 02/27/2024 09:16 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MUDANNAYAKE, THAMALKAFACILITY NUMBER:
573621640
ADMINISTRATOR:MUDANNAYAKE, THAMALKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 670-2705
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
02/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Thamalka MudannayakeTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Erwin Tjhia met with Licensee, Thamalka Mudannayake for the purpose of a case management inspection. The purpose of today's visit is to change Licensee's backyard from off limits to on limits. Census at the time of inspection were 11 children. Licensee's operating hours are Monday through Friday from 7:30 AM to 5 PM.

All individuals subject to criminal background review have obtained a criminal record clearance. 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.

LPA tour the backyard and observe no hazardous items accessible for the children. As of today 02/27/2024 the backyard will be changed to an on limits areas, accessible to children in care. Facility off limit areas are: all bedrooms, laundry room, and garage.

This facility evaluation report was reviewed and discussed with Licensee. A notice of site visit was provided and posted, and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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