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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197495082
Report Date: 12/01/2022
Date Signed: 12/01/2022 03:02:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/22/2022 and conducted by Evaluator Lillian J Casillas
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20221122164622
FACILITY NAME:EXCELSIOR PRESCHOOL TORRANCE LLCFACILITY NUMBER:
197495082
ADMINISTRATOR:JANEL MARTINEZFACILITY TYPE:
850
ADDRESS:19801 MARINER AVENUETELEPHONE:
(424) 375-6188
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:72CENSUS: 1DATE:
12/01/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Yashica Ansberry & Kiara OrtizTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Criminal Record Clearance: Uncleared staff working at facility
Reporting Requirements: Licensee did not report Director change to Department within 10 days
INVESTIGATION FINDINGS:
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On 12/1/2022, Licensing Program Analyst (LPA) Lillian Casillas arrived at this facility to initiate the complaint investigation regarding the allegations listed above. Upon arrival, LPA met with Assistant Director, Kiara Ortiz, and discussed the purpose of the inspection. The Chief Operating Officer (COO), Yashica Ansberry, was called and arrived shortly after. LPA observed 1 child and 3 staff.

During today’s inspection, LPA toured the facility and conducted interviews with the Assistant Director and COO. LPA also obtained a copy of the LIC 500 Personnel Report and reviewed the Assistant Director's personnel file. Assistant Director and COO stated the facility does not have a qualified director since the former director’s last day of employment in 10/2022. COO stated Staff 1 and Staff 2 do not have a criminal record clearance associated to the facility.

[CONTINUE ON PAGE 2]
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
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 4
Control Number 30-CC-20221122164622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: EXCELSIOR PRESCHOOL TORRANCE LLC
FACILITY NUMBER: 197495082
VISIT DATE: 12/01/2022
NARRATIVE
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PAGE 2

Based on admission of the COO and Assistant Director, as well as LPA's observation, and record review, there is a preponderance of evidence to prove the alleged violations did occur. Therefore, the allegations are SUBSTANTIATED. LPA issued a Type A deficiency pertaining to criminal record clearances (see LIC 9099-D for details) and an immediate civil penalty of $500 per uncleared adult. LPA also issued a Type B deficiency pertaining to reporting requirements (see LIC 9099-D for details).

Upon receipt of this report, the Licensee shall post the Notice of Site Visit (LIC 9213) and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. 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 of Receipt (LIC 9224) form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).



An exit interview was conducted, and a copy of the report was provided to the COO, along with Appeal Rights and the Notice of Site Visit.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 30-CC-20221122164622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: EXCELSIOR PRESCHOOL TORRANCE LLC
FACILITY NUMBER: 197495082
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2022
Section Cited
CCR
101170(e)(1)
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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health & Safety Code Section 1596.871 shall prior to working…in a licensed facility: (1) Obtain a California clearance…

This requirement was not met as evidence by:
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COO agrees to make sure staff obtain a criminal record clearance prior to working on-site. Uncleared individuals were asked to leave the facility during the inspection. COO agrees to provide a written statement to the Department by 12/16/2022 on how facility will comply with this requirement.
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Based on interviews, record review, and observation, Staff 1 and Staff 2 do not have criminal record clearances associated to this facility, which poses an immediately health, safety or 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: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 30-CC-20221122164622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: EXCELSIOR PRESCHOOL TORRANCE LLC
FACILITY NUMBER: 197495082
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2022
Section Cited
CCR
101212(b)
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101212 Reporting Requirements (b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change...This requirement was not as evidenced by:
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COO agrees to review the Child Care Reporting Requirements video https://ccld.childcarevideos.org/child-care-center-operators/child-care-reporting-requirements/ and train all administrative staff on reporting requirements for new director changes.
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Based on interviews and record review, the facility failed to report the Department of the interim director within 10 days, which poses a potential health, safety, or personal rights risk to children in care.
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COO agrees to provide LPA with a copy of the training agenda via email by 12/16/2022.
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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: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4