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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605264
Report Date: 09/16/2025
Date Signed: 09/16/2025 03:13:05 PM

Document Has Been Signed on 09/16/2025 03:13 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: 48CENSUS: 32DATE:
09/16/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:David Welch, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 9/16/2025 @ 1:00pm, Licensing Program Analyst (LPA) Devon Carus conducted a Case Management Unusual Incident inspection to follow up on the self- reported incident that occurred on 09/11/2025 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 9/12/2025. Upon arrival, LPA observed 32 children being supervised by 9 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 #1 (S1) and Staff Member #3 as the witnesses, Child #1 (C1), and the director (S2). The incident happened towards the end of the day during afternoon outdoor play time at 4:15pm. S1 initially noticed the incident, and treated the child’s wound with a paper towel that had water on it. S1 called to S3 to assist and additionally treated 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 four adults supervising 13-15 children on the playground.

According to the narrative provided by S1, S2, and S3, C1 was climbing on the cave play structure, and lost his footing and bumped his head. S1 was called to by C1 who identified that he had hit his head. S1 dressed the wound with a paper towel with water, and called to S3 who wrapped the child’s wound in gauze. S3 alerted the parents of C1 who came to take him to the doctor. Child returned the next day with glue to the laceration, a band aid on the wound, and a doctor’s note indicating no restrictions for the child.

LPA Carus inspected the climbing structure involved in the incident, and observed it to be safe, stable, secure, appropriate for the ages of children enrolled at the pre school, and free of tripping or slipping hazards.

During today’s visit, the director confirmed that since this incident occurred, the pre school has purchased additional grip strips to surround the footing areas of the play equipment as an additional precautionary measure. Furthermore, LPA Carus advised director to inform staff to keep a close eye on children playing on climbing equipment.

At this time, based on the available information, no violations will be cited today.
The content of this report was read and discussed in detail with David Welch, preschool director.
An exit interview was conducted. The notice of site visit must be posted for 30 days upon receipt.
NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
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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