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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494551
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:03:45 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/17/2024 and conducted by Evaluator Elicia Calvillo
COMPLAINT CONTROL NUMBER: 58-CC-20240917145023
FACILITY NAME:OUR LADY GRACE PRESCHOOLFACILITY NUMBER:
197494551
ADMINISTRATOR:THOMAS AMBRIZFACILITY TYPE:
850
ADDRESS:17720 VENTURA BLVDTELEPHONE:
(818) 344-4126
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY:15CENSUS: 13DATE:
01/15/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Thomas Ambriz, PrincipalTIME COMPLETED:
10:12 AM
ALLEGATION(S):
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Licensee does not ensure restrooms for preschool students are in proper working order
INVESTIGATION FINDINGS:
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***THIS IS AN AMENDED REPORT WHICH SUPERSEDES THE PREVIOUS REPORT***
On 12/12/2024 at 08:15 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegations. LPA identified self and met with Thomas Ambriz, Principal who allowed entry into the facility and provided LPA a guided tour of the inside and outside of the facility. Upon arrival there were 9 children and 2 staff.

During today’s visit, LPA addressed the allegations that licensee does not ensure restrooms for preschool students are in proper working order and staff do not provide adequate supervision to day care children while using the restroom. Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, interviewed Principal, interviewed parents, interviewed children, and interviewed staff.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 58-CC-20240917145023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: OUR LADY GRACE PRESCHOOL
FACILITY NUMBER: 197494551
VISIT DATE: 01/15/2025
NARRATIVE
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Information provided by the Reporting Party (RP) indicates that licensee does not ensure restrooms for preschool students are in proper working order and staff do not provide adequate supervision to day care children while using the restroom.

When interviewing Thomas Ambriz, Principal it was disclosed that there was an issue with the Preschool Restroom located in the Preschool classroom and repairs were needed. During the repairs, arrangements were made for the Preschool children to use the restrooms used by the Primary students and for Preschool children to be escorted and supervised by staff when using these restrooms.



When interviewing staff, staff disclosed that the Preschool restroom needed repairs, children used the Girls and Boys restrooms down the hall from the classroom, 2 staff escorted the boys and the girls to the restrooms, staff ensured that no other children were in the restroom with the Preschool children, and supervised the children at all times.

When interviewing parents, parents disclosed that the Preschool restroom was not working, their children used the “big kids potty”, and that their teachers went to the restroom with them.

When interviewing children, children disclosed that the restroom in the classroom was broken, they used the “big kids potty”, and their teachers went to the big kids restroom with them.

Based on LPA’s observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type B Citation, California Code of Regulations, Title 22, Division 12 Chapter 1, Section number 101238 (a) Buildings and Ground is being cited on the attached LIC 9099D.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Janet Eisenreich, Preschool Teacher including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20240917145023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OUR LADY GRACE PRESCHOOL
FACILITY NUMBER: 197494551
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2025
Section Cited
CCR
101238(a)
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101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by
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Principal Ambriz completed repairs to the classroom restroom. LPA observed the restrooms in working order.
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Based on observations, interviews, and record reviews that the investigations revealed that the Preschool Classroom restroom was not working, which poses a potential health, safety, and personal rights 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.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC9099 (FAS) - (06/04)
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