Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 09/08/2017
Date Signed 09/08/2017 03:42:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOLFACILITY NUMBER:
426213750
ADMINISTRATOR:TERESE MUNOZ-HILLFACILITY TYPE:
850
ADDRESS:219 W. OLIVE AVENUETELEPHONE:
(805) 735-7226
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:87CENSUS: 22DATE:
09/08/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Terese Munoz-HillTIME COMPLETED:
03:50 PM
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A case management visit was conducted by LPA S. Mendoza-Ceja who met with the Director regarding an incident that was reported to the Department on 08/16/2017 as required.

On August 16, 2017, there were concerns brought to the Director's attention regarding care and supervision in regards to child #1. LPA inspected the classrooms, interviewed some of the staff and reviewed child #1's file.

No deficiencies were cited.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2017
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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