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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208915
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:02:24 PM


Document Has Been Signed on 06/08/2022 12:02 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:MUSD CAMPUS CANYON PRESCHOOLFACILITY NUMBER:
566208915
ADMINISTRATOR:DEONNA ARMIJOFACILITY TYPE:
850
ADDRESS:15300 MONROE AVE.TELEPHONE:
(805) 531-6466
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY:46CENSUS: 0DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
10:00 AM
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On June 8, 2022 licensing Program Analyst Dean Thompson and Susana Martinez tried conducting an unannounced annual inspection. LPA's were advised the facility is currently closed until August 17, 2022 for summer break.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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