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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
566208795
Report Date:
04/21/2022
Date Signed:
04/21/2022 08:10:44 PM
Document Has Been Signed on
04/21/2022 08:10 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:
RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER:
566208795
ADMINISTRATOR:
CARMEN RODRIGUEZ
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(805) 231-8213
CITY:
THOUSAND OAKS
STATE:
CA
ZIP CODE:
91360
CAPACITY:
14
CENSUS:
DATE:
04/21/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:03 PM
MET WITH:
TIME COMPLETED:
02:15 PM
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LPA Thompson tried conducted an unannounced Annual/Random inspection on 4/21/2022. LPA Thompson also call tried calling licensee Carmen Rosa Rodriguez. LPA Thompson left a voicemail requesting a return phone call.
SUPERVISOR'S NAME:
George Mingle
TELEPHONE:
(805) 562-0411
LICENSING EVALUATOR NAME:
Dean Thompson
TELEPHONE:
(805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE:
04/21/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/21/2022
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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