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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561708227
Report Date: 11/30/2021
Date Signed: 11/30/2021 05:25:12 PM

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:VENTURA MISSIONARY PRESCHOOLFACILITY NUMBER:
561708227
ADMINISTRATOR:LAURIE PIDOFACILITY TYPE:
850
ADDRESS:500 HIGH POINT DRIVETELEPHONE:
(805) 644-9515
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:182CENSUS: 3DATE:
11/30/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Laurie PidoTIME COMPLETED:
05:30 PM
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An unannounced Legal Case Management inspection was conducted on November 30, 2021 at 4:30 PM by Licensing Program Manager George Mingle and Licensing Program Analyst (LPA) Laura Villanueva to provide the following letters regarding Travis Martin:

· ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY

· ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES:

LPM Mingle advised Director that Travis Martin is excluded from Ventura Missionary Preschool and any other licensed facilities by Department of Social Services. Appeal process and instructions have been provided.

The Confirmation of Removal licensing form 300E was provided during this inspection and shall be returned to the Regional Office no later than 12/06/2021.

Continued on LIC809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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: VENTURA MISSIONARY PRESCHOOL
FACILITY NUMBER: 561708227
VISIT DATE: 11/30/2021
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Exit Interview conducted with Director. Notice of Site Visit (LIC 9213) posted and – must remain posted for 30 consecutive days. Failure to maintain posting as required will result in a civil penalty of $100.00. A copy of Appeal Rights (LIC 9058 FAS 01/16) provided.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC809 (FAS) - (06/04)
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