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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320420
Report Date: 02/06/2025
Date Signed: 02/06/2025 07:23:10 PM

Document Has Been Signed on 02/06/2025 07:23 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:HAYWORTH TERRACEFACILITY NUMBER:
198320420
ADMINISTRATOR/
DIRECTOR:		MIRAN BAEFACILITY TYPE:
740
ADDRESS:325 N HAYWORTH AVETELEPHONE:
(323) 655-3101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY: 111CENSUS: 53DATE:
02/06/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:16 PM
MET WITH:Grace HwangTIME VISIT/
INSPECTION COMPLETED:
03:17 PM
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On February 6, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Proof of Correction (POC) visit. LPA Dabuet met with Assistant Administrator Grace Hwang and informed the staff that the purpose of this visit was to ensure that the Type B deficiencies cited during the Annual Inspection on January 16, 2025, were corrected as required and if the facility is now in compliance with Title 22 Regulations.

The deficiencies initially cited on January 16, 2025, were 87412(a), 87507(b), and 87506(b)(16). All proof of correction that was due by January 30, 2025, remained uncorrected.

Civil penalties have been issued.

An exit interview was conducted with Grace Hwang, and a copy of this report was provided.

Note: *Citations that are not cleared by the due date will incur a $100 fine for each citation until they are resolved. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared.*
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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