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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404132
Report Date: 09/25/2019
Date Signed: 09/25/2019 12:59:39 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:PACE HEAD START - WEST BOULEVARDFACILITY NUMBER:
197404132
ADMINISTRATOR:SILVA DE LA ROSAFACILITY TYPE:
850
ADDRESS:1809 WEST BLVD.TELEPHONE:
(323) 954-8099
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:68CENSUS: 43DATE:
09/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Marlia Figueroa, Lead TeacherTIME COMPLETED:
11:40 AM
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On 09/25/2019 at 09:40 am, Licensing Program Analyst (LPA) Sabrina Martinez conducted an unannounced inspection at Pace Head Start-West Boulevard located at 1809 West Blvd., Los Angeles, CA 90019 for the purpose of following up on the self reported unusual incident that occurred at the facility on 09/04/2019. The Unusual Incident/Injury Report (UIR) was received by the El Segundo Regional Child Care Office on 09/09/2019.

According to the Unusual Incident/Injury Report (UIR) that the Department received, on 09/04/2019 at 2:05 pm, staff #1 entered the office and noticed child#1 by the desk and was crying. Staff#1 approached child#1 and walked the child back to his class and informed staff#2 that the child was found at the teacher's office by the desk.

During this inspection, LPA conducted an interview with facility staff and obtained a copy of the sign in and sign out sheet dated 09/04/2019.

At this time, further investigation is needed.

An exit interview was conducted and a copy of this report was provided to Marlia Figueroa, Lead Teacher.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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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