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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494551
Report Date: 01/15/2025
Date Signed: 01/15/2025 10:56:40 AM

Document Has Been Signed on 01/15/2025 10:56 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:OUR LADY GRACE PRESCHOOLFACILITY NUMBER:
197494551
ADMINISTRATOR/
DIRECTOR:		THOMAS AMBRIZFACILITY TYPE:
850
ADDRESS:17720 VENTURA BLVDTELEPHONE:
(818) 344-4126
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 13DATE:
01/15/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:13 AM
MET WITH:Thomas Ambriz, PrincipalTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 01/15/2025 at 09:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Case Management -Other. LPA identified self and met with Thomas Ambriz, Principal who allowed entry into the facility and provided LPA a guided tour of the inside and outside of the facility. Upon arrival there were 13 children and 2 staff.

The purpose of the visit was to obtain signatures on an amended report.

There were no deficiencies cited during today’s inspection.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this report, appeal rights, and Notice of Site Visit was provided.

Exit interview was conducted with Thomas Ambriz, Principal.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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