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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605264
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:18:29 PM

Document Has Been Signed on 03/12/2025 05:18 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:MT. OLIVE LUTHERAN CHURCH PRESCHOOLFACILITY NUMBER:
191605264
ADMINISTRATOR/
DIRECTOR:		DAVID WELCHFACILITY TYPE:
850
ADDRESS:5975 ARMAGA SPRING ROADTELEPHONE:
(310) 377-8821
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 32DATE:
03/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:David Welch, DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 3/12/2025 @ 1:45pm, Licensing Program Analyst (LPA) Devon Carus conducted a Case Management Unusual Incident inspection to follow up on the self- reported incident that occurred on 02/4/2025 at Mt. Olive Lutheran Church Pre School located at 5975 Armaga Springs Road, Rancho Palos Verdes, CA 90275. The El Segundo Regional Office received the incident report on 2/5/2025. Upon arrival, LPA observed 46 children being supervised by five staff members. All center staff that was present during today’s inspection had fingerprint clearance and are associated to the designated license number.

LPA interviewed the following: Staff member #2 (S2) as the witness, Child #1 (C1) and the director (S1). The incident happened towards the end of the day during afternoon outdoor play time at 4pm. S2 initially noticed the incident, and was first to treat the child's wound with gauze. Based on the information gathered through interviews, and visual inspection of the playground (site of the incident), it revealed that were five adults supervising 25 children on the playground.

According to the narrative provided by S1 and S2, the incident took place during afternoon outdoor free play time. C1 was with two friends playing on the grass hill, and was rolling around near the wooden benches . S2 heard him yell, and immediately rushed over when he saw blood above C1's eyebrow. S2 then applied gauze to the wound, and S1 then called C1's parents. C1's parents arrived shortly after, and brought C1 to the doctor. C1 returned to school the next day with stitches, and an advisory from C1's mother stating that she does not want him running for the next few days.

During today’s visit, the director confirmed that since this incident occurred, the pre school is no longer allowing children to run, roll, or perform any boisterous activity in this grass area near the wooden benches. Additionally, LPA advised director to inform staff to keep a close eye on children playing in this area.

At this time, based on the available information, the center will be cited with (1) Technical Violation regarding a Title 22 violation for physical plant requirements.

The content of this report was read and discussed in detail with David Welch, preschool director.
An exit interview was conducted. Appeal rights were provided, and the notice of site visit must be posted for 30 days upon receipt.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Devon Carus
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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