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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495108
Report Date: 01/03/2025
Date Signed: 01/03/2025 03:19:13 PM

Document Has Been Signed on 01/03/2025 03:19 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER:
197495108
ADMINISTRATOR/
DIRECTOR:		ZURBRUGG, PHIL E.FACILITY TYPE:
850
ADDRESS:1350 W. 25TH STREETTELEPHONE:
(310) 833-3340
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 12DATE:
01/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Yolanda MojarroTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On 01/03/2025, Licensing Program Analyst (LPA) Tyra Chavies conducted an unannounced case management- incident visit to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 12/27/2024. Upon arrival, LPA met with Director, Yolanda Mojarro.  LPA informed director about the purpose of the visit and toured the facility. LPA observed 12 children being supervised by 2 teachers.

Incident Details:
4:15 PM on 12/26/2024, Tiana was sitting in a chair and had a seizure. I called the paramedic and then I called mom. Then the paramedic came at 4:20 pm, then the grandmother called and then mom called back. Once mom got there she left with the paramedics. Mom called and said she had a fever seizure. The child has not returned back to school.

Based on the information obtained the incident requires further investigation.

An exit interview was conducted, report was reviewed and provided to director, Yolanda Mojarro.

Notice of site visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Tyra Chavies
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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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