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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890359
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:56:46 PM

Document Has Been Signed on 01/10/2024 04:56 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:HADDON AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191890359
ADMINISTRATOR:CLAUDIA ARAUJOFACILITY TYPE:
850
ADDRESS:10085 HADDON AVE.TELEPHONE:
(818) 896-5501
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 166TOTAL ENROLLED CHILDREN: 166CENSUS: 63DATE:
01/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Martha Borquez, Local District DirectorTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Joe Katrdzhyan and Lilia Hernandez conducted an unannounced case management inspection to follow up on incidences reported to the Department. LPAs arrived at the facility at 2:12PM and met with Marietta Tambalo, Head Teacher, who guided LPA on a tour of the facility. LPAs were later met by Martha Borquez, Local District Director. There were 63 children and 15 staff present upon arrival.

The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA Hernandez conducted interviews and obtained documentation during this visit.

The incident that occurred on 11/30/2023, was reported to the Department on 11/30/2023, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that child #1 was playing outdoors in an area identified as the music area. Staff #1 and Staff #2 witness Child#1 slipped and hit their face on the platform of the music area. Staff #2 walked over to Child #1 saw nose bleeding and Staff #2 administered first aid. Parent was notified and issued a head injury report. Parent sought medical attention for Child# 1.

Child #1 returned to care on 12/4/2023 with a doctor's note with restrictions. On 1/03/2024, Facility received a doctors note for child #1 with no restrictions.

The incident that occurred on 12/05/2023, was reported to the Department on 12/07/2023, via telephone. The facility did not reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Child #2 personal rights may or may not have been violated.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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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: HADDON AVENUE EARLY EDUCATION CENTER
FACILITY NUMBER: 191890359
VISIT DATE: 01/10/2024
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Based on interviews conducted and documentation obtained, further information is needed to determine if Child #1 personal right may or may not have been violated.

There were no deficiencies cited during today’s inspection.

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

Exit interview conducted and report was reviewed with Martha Borquez, Local District Director.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
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