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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213009
Report Date: 12/31/2024
Date Signed: 12/31/2024 03:58:15 PM

Document Has Been Signed on 12/31/2024 03:58 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:THREE ANGELS PRE-SCHOOL AND INFANT CENTERFACILITY NUMBER:
566213009
ADMINISTRATOR/
DIRECTOR:		MARY WIGGINSFACILITY TYPE:
840
ADDRESS:6300 TELEPHONE RD.TELEPHONE:
(805) 639-0363
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 17DATE:
12/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Mary WigginsTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 12/31/2024, Licensing Program Analyst (LPA) German Negrete conducted an unannounced inspection at the Three Angels Center to deliver the findings of a complaint allegation received on 10/07/2024. LPA Negrete met with Director Mary Wiggins, and together they toured the center, both inside and out. LPA observed 2 staff providing care and supervision to the 17 children(school age).

During the course of the investigation LPA reviewed Children sing in/out sheets. LPA discovered on 12/19/2024 C#9 was signed in to the Facility at 2:30PM. However C#9 did not have a sign out recorded on C#9's sheet for 12/19/2024.

Tittle 22 California Code of Regulations will be cited (Type B) on LIC809-D page.

An exit interview was conducted, and the report was reviewed with the Director.

Appeal Rights were issued via email.

A notice of cite visit was provided via email.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/31/2024 03:58 PM - It Cannot Be Edited


Created By: German Negrete On 12/31/2024 at 01:58 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: THREE ANGELS PRE-SCHOOL AND INFANT CENTER
FACILITY NUMBER: 566213009

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
101229.1(b)

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The person who brings the child to, and removes the child from, the center shall sign the child in/out.
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Director will provide a memo to all parents who have children enrolled in the school age program. This memo will remind parents the imporatnce to follow title 22 section 101229.1(b). The parents will sign the memo. The director will email the signed memo to LPA via...
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Through document review, LPA discovered C#9 was signed in at 2:30PM on 12/19/2024, but C#9 did not have a documented sign out on C#9's time sheet
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german.negrete@dss.ca.gov.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:German Negrete
LICENSING EVALUATOR SIGNATURE:
DATE: 12/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/31/2024


LIC809 (FAS) - (06/04)
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