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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602272
Report Date: 02/27/2026
Date Signed: 02/27/2026 04:44:57 PM

Document Has Been Signed on 02/27/2026 04:44 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. TIMOTHY LUTHERAN PRESCHOOL DAY CAREFACILITY NUMBER:
191602272
ADMINISTRATOR/
DIRECTOR:		VELIA GUERRAFACILITY TYPE:
850
ADDRESS:4645 WOODRUFF AVETELEPHONE:
(562) 421-8441
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 72TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
02/27/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Facility RepresentativeTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
NARRATIVE
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On 02/27/2026 at 1:40pm, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced case management-incident inspection at the facility noted above. LPA met with facility representative and stated the purpose of today's visit. The purpose of the visit is to address two incidents the occurred on 02/17/2026 and 02/24/2026. Present during the time of the inspection were two staff and nine children.

Per facility representative, on 02/16/2026 when staff arrived at the facility, they observed that the roof in room 110 had collapsed. No children were present when staff arrived at 7:30am. Per facility representative, children will remain in the teddy bear room until the roof is fixed.

On 02/24/2026 at approximately 2:15pm, when LPA was touring the facility, facility representative stated that the rood in room 110 collapsed. LPA observed the debris on the ground near room 110. Per facility representative they did not report it to the Department. This is a potential safety risk to people in care. LPA reminded facility representative that unusual incidents shall be reported to the Department by telephone or fax within the Department's next working day and during its normal business hours.

During the inspection on 02/24/2026 at approximately 3:15pm LPA J. Culbert and facility representative were sitting in the director's office when an individual ran into the preschool requesting help. Facility representative checked the premises and locked down the school. LPA contacted the police and at approximately 3:25pm law enforcement arrived at the facility.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 02/27/2026 04:44 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 02/27/2026 at 12:25 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE
FACILITY NUMBER: 191602272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2026
Section Cited
CCR
101212(d)

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101212 (d)...during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department...within the Department's next working day...This requirement is not met as evidenced by

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During today's inspection, LPA J. Culbert collected unusual incident report and cleared the citation.
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Based on interview and record review, Licensee did not comply with the section cited above. During interview staff stated that the roof caved in on 02/18/2026 and they did not report it to the Department. This poses a potential health, safety or personal rights risk to persons in care.
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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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Jonnisha Culbert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2026


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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE
FACILITY NUMBER: 191602272
VISIT DATE: 02/27/2026
NARRATIVE
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One type B citation was issued for incident that occurred on 02/16/2026. Please see the attached LIC809D for more information.

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

Exit interview conducted and report was reviewed with facility representative.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC809 (FAS) - (06/04)
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