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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561711043
Report Date: 05/30/2025
Date Signed: 05/30/2025 12:35:17 PM

Document Has Been Signed on 05/30/2025 12:35 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KING OF GLORY PRESCHOOLFACILITY NUMBER:
561711043
ADMINISTRATOR/
DIRECTOR:		SHANNON MEYERSONFACILITY TYPE:
850
ADDRESS:2500 BORCHARD ROADTELEPHONE:
(805) 498-0567
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 0DATE:
05/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Shannon MeyersonTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 5/30/25 Licensing Program Analyst (LPA) Veronica Diaz conducted an unannounced inspection to deliver the findings of the above-mentioned allegation. LPA met with site director Shannon Meyerson and advised them for the purpose for this inspection. At the time of inspection there were 0 children in the care director and staff are preparing the preschool for summer camp. Children will be back Monday.

On 2/20/2025, Director Shannon Meyerson contacted Community Care Licensing (CCL) to self-report an incident of a parent who witness a Staff (S1) on 11/19/24, remove a child (C1) from a play structure aggressively. The parent (P1) visually observed the incident in the yard. Director states S1 was written up for the incident. This incident was not reported to the Department in a timely manner. Director further reported that on 02/12/25, several teachers and the church Pastor observed S1 pulling children from the upper arms, wrists, and pulling on a few occasions.

Interviews determined, (S1) was placed on administrative leave on 02/24/2025. Interviews and documents reviewed by LPA, show S1 employment was terminated on 03/03/2025. LPA conducted file reviews and interviews with current and past staff. The facility acknowledged they are being transparent and ensuring the safety of the children in their care.

During today’s inspection the following deficiencies were issued:
One Type B deficiency for Reporting Requirements

A notice of site visit was given and must remain posted for 30 days.


Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted, appeal rights were given, and report was reviewed with director Shannon Meyerson.
NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Veronica Diaz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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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Document Has Been Signed on 05/30/2025 12:35 PM - It Cannot Be Edited


Created By: Veronica Diaz On 05/30/2025 at 11:47 AM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KING OF GLORY PRESCHOOL
FACILITY NUMBER: 561711043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
Section Cited
CCR
101212(a)(d)(C)(D)

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101212 Reporting Requirements
(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following:...

This requirements is not met as evidence by:
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Director submitted training, Unusual Incident report to the department. Director agreed to have an informal meeting with management at the SBRO at a letter time
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Based on interviews and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety, or personal rights risk to persons 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.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Veronica Diaz
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2025


LIC809 (FAS) - (06/04)
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