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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197405297
Report Date:
06/16/2022
Date Signed:
06/16/2022 09:43:05 AM
Document Has Been Signed on
06/16/2022 09:43 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
CCLD Regional Office
,
6500 HOLLISTER AVE., SUITE 200
GOLETA
,
CA
93117
FACILITY NAME:
ILAN RAMON DAY SCHOOL
FACILITY NUMBER:
197405297
ADMINISTRATOR:
VALERIE SEGALL
FACILITY TYPE:
850
ADDRESS:
27400 W. CANWOOD ST.
TELEPHONE:
(818) 707-2365
CITY:
AGOURA HILLS
STATE:
CA
ZIP CODE:
91301
CAPACITY:
90
CENSUS:
DATE:
06/16/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
TIME COMPLETED:
09:30 AM
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LPA Thompson tried conducting an unannounced annual inspection on 6/16/2022. LPA was informed the facility is closed for Summer break and will open August 30th..
SUPERVISOR'S NAME:
George Mingle
TELEPHONE:
(805) 562-0411
LICENSING EVALUATOR NAME:
Dean Thompson
TELEPHONE:
(805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2022
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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