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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213009
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:52:23 PM

Document Has Been Signed on 11/01/2022 04:52 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:THREE ANGELS PRE-SCHOOL AND INFANT CENTERFACILITY NUMBER:
566213009
ADMINISTRATOR:MARY WIGGINSFACILITY TYPE:
840
ADDRESS:6300 TELEPHONE RD.TELEPHONE:
(805) 639-0363
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 8DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:26 PM
MET WITH:Mary WigginsTIME COMPLETED:
05:20 PM
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On November 11, 2022 at 03:26 PM, Licensing Program Analyst (LPA) Rona Chavez conducted an unannounced Annual/Random inspection. LPA met with Director Mary Wiggins and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were eight children in care and one (1) staff supervising.

The facility is using one (1) classroom/gym for the school age program. LPAs observed licensing required documents posted prominently on the wall at the entrance of the class and office. The center has sufficient amount of restrooms for the children to use. LPAs observed age appropriate toys, activities, books, and furniture readily accessible for children to use. The center does not provide meals or snacks for the children. Children bring their own snacks to center. LPA observed the playground to have age appropriate toys and play structures. LPA did not observe any toxins or hazards. Children bring water bottles from home and center provides filtered water to refill. Facility is not currently providing Incidental Medical Services (IMS) to children in care.

LPAs observed the sign-in/sign-out sheet and roster to be current. LPAs reviewed a sampling of children and staff records. Children records were complete and current. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Staff present were fully qualified with current Mandated Reporter certificate that expire on 8/1/2024 and CPR/First-aid certificates that expire on 8/1/2024. Fire drill was documented and completed every six months.

Continued on 809-C


SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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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: THREE ANGELS PRE-SCHOOL AND INFANT CENTER
FACILITY NUMBER: 566213009
VISIT DATE: 11/01/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Mary Wiggins.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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