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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418525
Report Date: 04/20/2023
Date Signed: 04/20/2023 06:11:18 PM

Document Has Been Signed on 04/20/2023 06:11 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:HERITAGE CHRISTIAN PRESCHOOLFACILITY NUMBER:
197418525
ADMINISTRATOR:DOLORES ENGLISHFACILITY TYPE:
850
ADDRESS:10949 ZELZAH AVENUETELEPHONE:
(818) 488-8888
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 120TOTAL ENROLLED CHILDREN: 81CENSUS: 1DATE:
04/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:23 PM
MET WITH:Margaret MillerTIME COMPLETED:
06:15 PM
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On 04/20/2023 at 5:23 pm Licensing Program Analyst (LPA) Deborah Lowe arrived at facility to conduct an unannounced case management – incident visit and met with Facility Representative Margaret Miller.

On 04/20/2023 the facility self reported an unusual incident. Unusual Incident – On 04/20/2023 a child had a seizure, 911 was called, and child was transported to the hospital.

LPA toured the facility and observed 1 child in care and under supervision of 2 staff, S2 and S3.

LPA collected a copy of the facility Enrollment Report, Personnel Roster, and copy of the child’s file. Facility will email LPA Lowe the facility Children’s Roster on 04/21/2023.

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.

Appeal rights were reviewed and provided to facility representative.

Exit interview conducted and report was reviewed with the facility representative Margaret Miller.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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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