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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494608
Report Date: 10/23/2023
Date Signed: 10/23/2023 03:58:55 PM

Document Has Been Signed on 10/23/2023 03:58 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:OUR LADY OF MALIBU CHURCH AND SCHOOLFACILITY NUMBER:
197494608
ADMINISTRATOR:REV MATHEW MURPHYFACILITY TYPE:
850
ADDRESS:3625 S WINTER CANYON RDTELEPHONE:
(310) 456-8071
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 7DATE:
10/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Rich Nambu, PrincipalTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management visit citing for a deficiency observed during an inspection. LPA arrived at the facility at 9:20AM and met with Rich Nambu, Principal who guided LPA on tour of the facility. There were 7 children and 1 staff present upon arrival.

Upon arriving at 9:20AM, LPAs observed Principal working at the facility prior to a criminal record clearance. Principal was not listed on the facility roster.

Principal Nambu has been employed at the facility since August 2021 to present. Principal states that fingerprint clearance was completed with the Archdiocese of Los Angeles. However, background clearance was not completed through the Department.

Principal Nambu called the Los Angeles Archdiocese regarding his background clearance with the Department.

Principal Nambu was told that the Archdiocese should have processed fingerprints since his school is a licensed facility.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. ---Page 1 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: OUR LADY OF MALIBU CHURCH AND SCHOOL
FACILITY NUMBER: 197494608
VISIT DATE: 10/23/2023
NARRATIVE
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Principal was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

The Notice of Site Visit 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 Rich Nambu, Principal, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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Document Has Been Signed on 10/23/2023 03:58 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 10/23/2023 at 03:21 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: OUR LADY OF MALIBU CHURCH AND SCHOOL
FACILITY NUMBER: 197494608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2023
Section Cited
CCR
101170(a)

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101170(a)
The Department shall conduct a criminal record review of all persons specified in Health and Safety Code Section 1596.871(b). The Department has the authority to approve or deny a facility license, or employment, residence or presence in the facility, based on the results of this review.
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Per Principal, Livescan Request will be processed with the support of the Los Angeles Archdiocese and proof of clearance will be submitted to LPA by 11/01/2023.
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This requirement was not met as evidenced by:
Records reviewed and disclosures made indicating that Principal did not conduct a criminal background clearance with the Department prior to employment which poses an immediate 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.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2023


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