Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213009
Report Date: 12/06/2016
Date Signed 12/06/2016 04:52:59 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: 9DATE:
12/06/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:44 PM
MET WITH:Mary (Lee Flum, Co-DirectorTIME COMPLETED:
05:00 PM
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(3) 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 Flum and together a tour of the facility was conducted inside and out. This program is conducted in the gym and the children use the restroom that is outside the building therefore are escorted to and from. LPA observed the process as a child had to use the restroom while LPA was present and therefore all kids had to line up to go. The emergency fire drill log is maintained in the office and drills are conducted routinely. Medication is stored in the kitchen however Ms Flum stated are not currently handling medications. Fire Extinguisher is inspected annually as well as smoke detectors and met Title 22 regulations. There were no hazards or toxins observed in the classroom or bathrooms.

Children's records were not reviewed as the directors office was locked and the director had already left for the day. LPA verified that persons who signed out children were listed on the LIC 700. LPA verified Ms Flum is current in CPR and First training. Ms Flum has been the school age teacher for four years and became the co-director three years ago.

LPA verified the center is not providing Incidental Medical Services at this time. LPA advised if they start providing IMS in the future they must submit a plan.


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: 12/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2016
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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