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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870741
Report Date: 08/15/2019
Date Signed: 08/15/2019 01:32:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HAWAIIAN AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191870741
ADMINISTRATOR:AGUET, DEBORAHFACILITY TYPE:
850
ADDRESS:501 HAWAIIAN AVE.TELEPHONE:
(310) 834-7186
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY:117CENSUS: 70DATE:
08/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Bernadette Guerrero/Head TeacherTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Silva Garibyan arrived at the facility and met with Bernadette Guerrero /Head Teacher. LPA toured the facility inside and outside on 8/15/19 at 11:30 a.m. LPA observed 70 children and five teachers and 11 aides present.

The incident report was documented by Deborah Aguet, Principal, dated July 31, 2019 ( Wednesday). The incident occurred on July 26, 2019 ( Friday). The incident was reported to principal Aquet on July 31, 2019 and was faxed to the Department on 07/31/2019.

The incident involves a possible Personal Rights Violation ( Staff #1 interacted with Child #1 in a inappropriate manner).


LPA interviewed teachers. The incident needs further investigation and interviews.

Exit interview was conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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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