Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213009
Report Date: 06/09/2015 12:00:00 AM
Date Signed 06/09/2015 01:32:25 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:THREE ANGELS PRE-SCHOOL AND INFANT CENTERFACILITY NUMBER:
566213009
ADMINISTRATOR:MARY WIGGINSFACILITY TYPE:
840
ADDRESS:6300 TELEPHONE RD.TELEPHONE:
(805) 639-0363
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:28CENSUS: 16DATE:
06/09/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Mary WigginsTIME COMPLETED:
01:35 PM
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LPA Merkes conducted an unannounced site visit at this Child Care Center for the purpose of a Random annual review. LPA Merkes met with Ms Wiggins and together a tour of the facility was conducted inside and out. The emergency fire drill log is maintained in the office and drills are conducted quarterly. Director stated they are not currently handling medications at this time. Fire Extinguisher and smoke detectors are inspected annually; last inspection 6/1/15. There were no hazards or toxins observed in the classrooms or bathrooms.

Children's and staff files were reviewed. Children's roster is intact


No deficiencies were cited.
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Stacie MerkesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2015
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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