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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404132
Report Date: 09/26/2019
Date Signed: 09/26/2019 02:59:05 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: 30DATE:
09/26/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Marlia Figueroa, Lead TeacherTIME COMPLETED:
03:00 PM
NARRATIVE
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On 09/26/2019 01:15 pm, 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 the child involved in the incident. Based on interviews conducted, it was revealed that on 09/04/2019, facility staff failed to supervise children in the classroom. As a result, child#1 opened the classroom door leading to the teacher's office. Child#1 was alone and unsupervised in the teacher's office until staff#1 found the child and brought the child back to the classroom. After the incident, the facility has installed door latches and replaced the batteries on the door alarms.

Based on the available information, it appears that the incident was the result of a Title 22 violation for lack of supervision. Facility was cited a Type B violation today, 09/26/2019. (See LIC 809-D for deficiency cited.)

An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit were 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: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 BOULEVARD
FACILITY NUMBER: 197404132
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2019
Section Cited

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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, ... Supervision shall include visual observation.

This requirement is not met as evidenced by: On 09/04/2019 at approx. 02:05 pm, facility staff failed to supervise children in
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n the classroom. As a result, child#1 opened the classroom door leading to the teacher's office. Child#1 was alone and unsupervised in the teacher's office until staff#1 found the child and brought the child back to the classroom. This is a Type B citation and poses a potential health and safety risk to children in care.
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conduct an in-service training on the importance of care & supervision, including but not limited to visual observation. Copy of agenda & sign in sheets of staff members in attendance will be submitted on/or before closing of business day, 09/30/19. The documents will be emailed to sabrina.martinez@dss.ca.gov.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
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