<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416554
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:02:16 PM


Document Has Been Signed on 02/10/2023 03:02 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:INTERNATIONAL CHILDREN'S ACADEMYFACILITY NUMBER:
197416554
ADMINISTRATOR:HAMDAM "SHANAZ" HOORFARFACILITY TYPE:
850
ADDRESS:1046 S ROBERTSON BLVDTELEPHONE:
(310) 657-6798
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:81CENSUS: 11DATE:
02/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Hamdam Shanaz Hoorfar, Director TIME COMPLETED:
02:58 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPAs), Denise Miranda, conducted an unannounced case management inspection on 02/10/2023 at :2:16PM. LPA met with Hamdam Shanaz Hoorfar, Director, who guided analyst on a tour of the facility. There were 11 children being supervised by 3 staff.

Due the Shabah, LPA will continue her case management another time.

Director is aware, about the facility physical plant and files will be review later.

Exit interview was conducted with Hamdam Shanaz Hoorfar, Director, and copy of this report was provided and review with Ms. Hamdam Shanaz Hoorfar, Director.

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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 1