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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493099
Report Date: 06/30/2023
Date Signed: 06/30/2023 09:46:44 AM

Document Has Been Signed on 06/30/2023 09:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HUMBLE HEARTS ACADEMYFACILITY NUMBER:
197493099
ADMINISTRATOR:AMANDA FRYFACILITY TYPE:
850
ADDRESS:13325 HAWTHORNE BLVD.TELEPHONE:
(424) 209-2537
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 39TOTAL ENROLLED CHILDREN: 39CENSUS: 24DATE:
06/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Araceli Gonzalez, Interim DirectorTIME COMPLETED:
10:00 AM
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On 6/30/2023, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management incident inspection to follow up on an Unusual Incident reported to the department by telephone on 6/27/2023. LPA was greeted by Interim Director Araceli Gonzalez. LPA toured the facility and took a census of the children. Upon arrival, there were 24 children and 4 staff present today.

Description of the incident: Facility reported on 6/26/2023 at 12:00pm during nap time, C1 began to have a seizure. The facility called 911 and C1 parents. The paramedics arrived to the facility and transported C1 to the hospital. Staff accompany C1 in the paramedics.

During this inspection, toured the facility, interview staff, conducted a record review and obtained a copy of C1 file and the facility roster.

Based on the information provided the incident will require further investigation.

An exit interview was conducted, a copy of this report and notice of site was provided to Interim Director, Araceli Gonzalez.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2023
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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