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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495108
Report Date: 02/07/2025
Date Signed: 02/07/2025 01:00:52 PM

Document Has Been Signed on 02/07/2025 01:00 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: DATE:
02/07/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Yolanda MojarroTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On 02/07/2025 Licensing Program Analyst (LPA) Tyra Chavies arrived at the above named facility to conduct an unannounced case management visit. 

LPA Chavies arrived at facility and was let in by unknown parent. Upon entering the office space, there was no staff members present. LPA observed C1 in a connecting classroom with no teacher/staff member present.  This is a Type “A” violation that present an immediate risk to the health, safety, or personal rights of the children in care.

Technical:
LPA Chavies located S1 in the classroom and advised S1 of C1 being left alone on other side of the classroom. S1 proceeded to go get C1 leaving C2 in restroom and C3 eating breakfast without visual supervision. LPA Chavies advised S1 that no child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).  Supervision shall include visual observation as well.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Tyra Chavies
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GOOD SHEPHERD'S FOLD PRESCHOOL
FACILITY NUMBER: 197495108
VISIT DATE: 02/07/2025
NARRATIVE
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Technical:
While touring the facility LPA Chavies observed 10 children being cared for and supervised by 1 staff while a door was open to an OFF LIMIT area and S2 back was turned on C1, C2, C3, C4 and C5. Per S2, "A teacher just left out, that's why the door is open." Per administrator, "This door is usually closed." A best practice, the CCC should always make sure OFF LIMIT area remain inaccessible while children are in care.

Exit interview conducted and copy of report and appeal rights were reviewed  and provided to Director, Yolanda Mojarro.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, Technical Assistance and A citation was given today. See LIC 9102 See LIC 809D. See LIC 421IM.

A Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Tyra Chavies
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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Document Has Been Signed on 02/07/2025 01:00 PM - It Cannot Be Edited


Created By: Tyra Chavies On 02/07/2025 at 12:21 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GOOD SHEPHERD'S FOLD PRESCHOOL
FACILITY NUMBER: 197495108

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2025
Section Cited
HSC
101229(1)

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(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Staff all supervise visually at all times
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Based on records review, the licensee did not comply with the section cited above. LPA observed C1 in a connecting classroom with no teacher/staff member present which poses an immediate Health, Safety and, 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.
SUPERVISOR'S NAME:Karren Starks
LICENSING EVALUATOR NAME:Tyra Chavies
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


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