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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890345
Report Date: 08/02/2024
Date Signed: 08/02/2024 12:55:27 PM

Document Has Been Signed on 08/02/2024 12:55 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/
DIRECTOR:		LESSLY MORAFACILITY TYPE:
850
ADDRESS:11300 KITTRIDGE ST.TELEPHONE:
(818) 985-1790
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 48DATE:
08/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:31 AM
MET WITH:Lessly Mora, PrincipalTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to self reported incidences that occurred at the facility. LPA arrived at the facility at 9:31AM and met with Martha Rivera, Designee. LPA singularly conducted a tour of the facility. There were 48 children and 13 staff present upon arrival. LPA was later met with Lessly Mora, Principal.

The incident that occurred on 07/15/2024, was reported to the Department on 07/15/2024, via email. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Staff #1 may or may not have violated the personal rights of Child #1 while in care.

LPA conducted interviews with Principal, Staff #1, Staff #2, and Child #1 and obtained written statements for this incident.

Based upon information received from the interviews conducted it was determined the personal rights of Child #1 were not violated for the incident dated 07/15/2024.

The incident that occurred on 07/30/2024, was reported to the Department on 07/30/2024, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Staff #1 may or may not have violated the personal rights of Child #2 while in care.

LPA conducted interviews with Principal, Staff #1, Parent #2, and Child #2 and obtained written statements for this incident. ---Page 1 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 191890345
VISIT DATE: 08/02/2024
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Based upon information received from the interviews conducted it was determined that the personal rights of child #1 were not violated for the incident dated 07/30/2024.

There were no deficiencies cited during today’s inspection.

The Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted and report was reviewed with Lessly Mora, Principal.
---Page 2 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC809 (FAS) - (06/04)
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