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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890345
Report Date: 05/04/2023
Date Signed: 05/04/2023 12:07:31 PM

Document Has Been Signed on 05/04/2023 12:07 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:FAIR AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191890345
ADMINISTRATOR:VIKEN KAZARIANFACILITY TYPE:
850
ADDRESS:11300 KITTRIDGE ST.TELEPHONE:
(818) 985-1790
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 70DATE:
05/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Lessly Mora, Principal TIME COMPLETED:
12:20 PM
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On 05/04/2023 Licensing Program Analysts (LPAs) Lilia Hernandez and Silva Garibyan, conducted a case management Incident inspection to follow up on the self reported incident that occurred at Fair Ave Early Education Center on 04/25/2023. The El Segundo Child Care Office received the incident report via Telephone and email on 04/25/2023. In the unusual incident report (UIR) it was alleged that a child was inappropriately touched by another child. Mother of the Child 1 reported the incident to the principal. Per mother's statement, the incident took places 3-4 weeks ago.

LPAs met with Lessly Mora, Principal. LPAs explained the purpose of the visit and was granted entry into the facility. Principal guided LPAs on a tour of the facility. LPAs observed 70 children and 13 staff members. In classroom 1A: 14 children and 3 staff were present and in 1B: 15 children and 3 staff present.

During today's visit LPAs conducted classroom observation, interviewed principal, teachers and children. LPAs collected and reviewed the following supportive documents: daily classroom schedule, staff daily schedule, classroom roster, and sign-in/sign-out sheets. LPAs also took pictures of the facility.

At this time, further investigation is needed.

The notice of site visit must be posted for 30 days.
An exit interview was conducted and a copy of this report was given to Lessly Mora, Principal.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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