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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500117
Report Date: 06/24/2025
Date Signed: 06/24/2025 02:32:45 PM

Document Has Been Signed on 06/24/2025 02:32 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CALVARY PRESCHOOLFACILITY NUMBER:
191500117
ADMINISTRATOR/
DIRECTOR:		MOLLY SPRAGGFACILITY TYPE:
850
ADDRESS:1050 FREMONT AVE.TELEPHONE:
(626) 799-0385
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 134TOTAL ENROLLED CHILDREN: 134CENSUS: 51DATE:
06/24/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Elise Contreras, Lead Teacher/Campus LeaderTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
NARRATIVE
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On June 24, 2025, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management - Incident inspection at the above facility. LPA met with Campus Leader, Elise Contreras who guided LPA on a tour of the facility. LPA observed 51 children in care.

The purpose of the inspection is to follow up on an incident that occurred on 06/16/2025 and was reported to the department on 06/20/2025. The incident report was not reported in a timely manner. The facility is being cited a Type B deficiency in accordance with Title 22 Regulations, Reporting Requirements 101212(d).

During the inspection, LPA interviewed Staff #1 (S1) to Staff #2 (S2), Child #1 (C1), obtained a current facility roster and obtained a written statement from Parent #1 (P1) and other relevant documents. LPA was unable to interview Child #2 (C2) as C2 was absent from the facility.

Per S1, P1 was walking toward the facility gate to pick up their child. S1 stated that while P1 was walking toward the facility entrance, P1 observed C1 and C2 having an inappropriate interaction/conduct with one another. Per S1, S1 was not in the area where the incident occurred and immediately went to the outdoor area to inform S2 of what P1 had informed S1 about (inappropriate conduct with C1 and C2). Per S2, S2 pulled C1 and C2 aside and asked both children what had occurred. Per S2, C1 did not want to disclose that anything had occurred. Per S2, C2 disclosed there was an inappropriate interaction with C1. Per S2, S2 thoroughly questioned C1 and C2 about the incident and brought the children into the directors office. Per S2, S2 informed the director of what had occurred. Per S2, parents of C1 and C2 were notified of the incident.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2025
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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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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CALVARY PRESCHOOL
FACILITY NUMBER: 191500117
VISIT DATE: 06/24/2025
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Per S2, S2 did not observe the incident had occurred and was not aware of the incident until S1 brought it to S2's attention. LPA reviewed P1's written statement and it stated that P1 observed the incident and immediately notified a staff member.

LPA reminded the facility staff the duties and responsibilities of being a mandated reporter. LPA informed facility when asking children questions, there may need to be a parental consent to ensure there are no boundaries being crossed with further questioning.

The facility is being cited a Type A deficiency in accordance with Title 22 Regulations, Responsibility for Providing Care and Supervision, 101229(a)(1). Deficiencies that are being cited need to be cleared to protect the children's health and safety.

LPA Ayala informed Campus Lead, Elise Contreras that this report dated 06/24/2025, documents One Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, and personal rights of children in care.

Also, LPA Ayala informed the Campus Lead to provide a copy of this licensing report dated 06/24/2025, that documents any Type A citation, to parent/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Campus Lead, Elise Contreras and a copy of this report was provided along with Appeal Rights. A Notice of Site Visit was provided and must be posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2025 02:32 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 06/24/2025 at 02:11 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CALVARY PRESCHOOL
FACILITY NUMBER: 191500117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement was not met as
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Executive Director will have an all staff meeting with staff reviewing the supervision policy and zoning. Executive director will submit agenda and sign in sheets of staff who attended by POC date (07/07/2025).
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evidence by: Based on interviews conducted, S1 was notified of the incident by P1. S1 informed S2 who was on the yard with children on the incident and was unaware the incident had occurred. This poses an immediate health and safety risk to children 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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2025 02:32 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 06/24/2025 at 02:13 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CALVARY PRESCHOOL
FACILITY NUMBER: 191500117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
101212(d)

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Reporting Requirements: Upon the occurrence, 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 by telephone or fax within the Department's next working day and during its normal business hours... This requirement
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Executive director will review Reporting Requirement regulation and will forward any unusal incidents as directed by Ttitle 22 in the future.
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was not met as evidence by: Based on record reivew, the incident occurred on 06/16/2025 and was not reported to the department until 06/20/2025. This poses a potential health and safety risk for children 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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2025


LIC809 (FAS) - (06/04)
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