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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300607185
Report Date:
06/16/2022
Date Signed:
06/16/2022 03:52:54 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
06/16/2022 03:52 PM
- 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
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
WAGNER PRESCHOOL
FACILITY NUMBER:
300607185
ADMINISTRATOR:
CUESTA, SYLVIA
FACILITY TYPE:
850
ADDRESS:
717 E YORBA LINDA BLVD
TELEPHONE:
(714) 996-0563
CITY:
PLACENTIA
STATE:
CA
ZIP CODE:
92870
CAPACITY:
71
CENSUS:
0
DATE:
06/16/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:34 AM
MET WITH:
Sylvia Cuesta, Director
TIME COMPLETED:
12:45 PM
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SUPERVISOR'S NAME:
Thuy Ho
TELEPHONE:
(714) 287-8515
LICENSING EVALUATOR NAME:
Stacy Torrence
TELEPHONE:
(714) 300-3599
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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