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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208585
Report Date: 11/01/2022
Date Signed: 11/01/2022 05:07:20 PM


Document Has Been Signed on 11/01/2022 05:07 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:THREE ANGELS PRESCHOOL AND INFANT CENTERFACILITY NUMBER:
566208585
ADMINISTRATOR:MARY WIGGINSFACILITY TYPE:
830
ADDRESS:6300 TELEPHONE RD.TELEPHONE:
(805) 639-0363
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:20CENSUS: 17DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Mary WigginsTIME COMPLETED:
03:25 PM
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On November 01, 2022 1:19 PM, Licensing Program Analyst (LPA) Rona Chavez conducted a Required Annual inspection. LPA met with Director Mary Wiggins and advised her the purpose of the inspection. LPA conducted a tour of the facility inside and out. There were 17 children in care at the time of the inspection with five staff.

The center operates from 6:45 AM to 6:30 PM Monday thru Friday. This is a combination center with a pre-school and school-age program. All required licensing forms were posted in the office and classroom of the center. The center uses two classrooms for the infant program. Center does not provide meals for the children in care. Parents provide meals and snacks, LPA observed the food to be stored properly and labeled. The refrigerator had each child's formula, sipping cups and bottles with labels. LPA observed activity schedule posted. The restrooms were found clean and free of toxins. LPA observed chemicals on the bottom shelf in the laundry room in the hallway out side of the class room door. Typically the door is locked but the door was left open. Director stated the door should be locked and locked the door immediately. LPA observed a working carbon monoxide/smoke detector. LPA observed age appropriate furniture, equipment and toys in the class rooms. There was a diaper changing tables within an arm's reach to the sink. Facility has sufficient amount of cribs. At the time of the inspection the one year old class was at nap time.

Cont on 809C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona ChavezTELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: THREE ANGELS PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 566208585
VISIT DATE: 11/01/2022
NARRATIVE
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 LPA viewed staff physically checking on the children while they were sleeping. Staff were not able to provide current documentation of the 15 minute check sleep logs. Staff in the 1 year old class were not aware that it applied to their classroom. Staff in the infants class 12 months and younger had previously done the sleep logs but was not able to provide current logs. LPA also observed several infants in the 1 year old class had blankets in their cribs. LPA reviewed safe sleep regulations with director and provided resources. The outdoor play area is completely fenced and LPA observed age appropriate toys, equipment and shade. Drinking water is available inside and outside.

Center uses written sign in sheets. Teacher files reviewed and were found complete with State required forms. Teacher's Medical Health Records verified. Teachers are current with CPR and First Aid which expires 08/01/2024. Center staff completed Mandated Reporter Training and has an expiration date of 8/1/2024. Children's files reviewed and found complete. Each child had their infant needs and services plan. Fire drill log is current with a fire drill conducted every 6 months. Center is not currently providing IMS.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona ChavezTELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: THREE ANGELS PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 566208585
VISIT DATE: 11/01/2022
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

One Type B deficiency is being cited and one Technical Violation is being issued during today's inspection. See attached LIC 9102 and LIC 809-D.

A notice of site visit was given and must remain posted for 30 days.


Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director Mary Wiggins.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona ChavezTELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/01/2022 05:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: THREE ANGELS PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 566208585

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above by not documenting 15 minute checks on 17 infants in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2022
Plan of Correction
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Licensee agrees to start documeting 15 mintue checks for all children under the age of two (2) years and will send tracking sheet via email to rona.chavez@dss.ca.gov by 11/05/22
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona ChavezTELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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