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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
566212655
Report Date:
06/15/2022
Date Signed:
06/15/2022 03:21:25 PM
Document Has Been Signed on
06/15/2022 03:21 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:
CONEJO ADVENTIST PRESCHOOL
FACILITY NUMBER:
566212655
ADMINISTRATOR:
TERESA CABRERA
FACILITY TYPE:
850
ADDRESS:
1250 ACADEMY DRIVE
TELEPHONE:
(805) 498-2391
CITY:
NEWBURY PARK
STATE:
CA
ZIP CODE:
91320
CAPACITY:
30
TOTAL ENROLLED CHILDREN:
30
CENSUS:
DATE:
06/15/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:30 PM
MET WITH:
TIME COMPLETED:
01:50 PM
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LPA Thompson and Susana Martinez tried conducting an unannounced annual inspection. LPA's were informed the facility is closed for Summer break and will open for four weeks next week.
SUPERVISORS NAME
:
George Mingle
LICENSING EVALUATOR NAME
:
Dean Thompson
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/15/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/15/2022
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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