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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
566213597
Report Date:
06/09/2022
Date Signed:
06/13/2022 08:55:24 AM
Document Has Been Signed on
06/13/2022 08:55 AM
- 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:
STEELE FCC AKA SHADOW OAKS DAYCARE
FACILITY NUMBER:
566213597
ADMINISTRATOR:
ELYSSA STEELE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(805) 497-7787
CITY:
THOUSAND OAKS
STATE:
CA
ZIP CODE:
91360
CAPACITY:
14
CENSUS:
DATE:
06/09/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:56 PM
MET WITH:
TIME COMPLETED:
01:15 PM
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LPA Dean Thompson and Susana Martinez tried conducted and unannounced annual inspection on 6/9/2022 at 12:56 PM. Licensee was not home during the time of the visit. LPA Thompson left a voicemail message 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:
06/13/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2022
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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