197404132-2-4-2022-30-CC-MRUZ-CBEM3M-20220207081520

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197404132
Report Date: 02/04/2022
Date Signed: 02/04/2022 09:45:22 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2021 and conducted by Evaluator Lisa Clayton

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20211109111127

FACILITY NAME:	PACE - WEST BOULEVARD		FACILITY NUMBER:	197404132
ADMINISTRATOR:	SILVA DE LA ROSA		FACILITY TYPE:	850
ADDRESS:	1809 WEST BLVD.		TELEPHONE:	(323) 954-8099
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90019
CAPACITY:	68	CENSUS: 28	DATE:	02/04/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	MYRA SABAS, REGIONAL SITE DIRECTOR		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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PERSONAL RIGHTS: Facility is discriminating.

INVESTIGATION FINDINGS:

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On 02/04/2022, LPA Clayton conducted an un-announced visit to deliver the findings on the above allegations. LPA was greeted by Myra Sabas, Regional Site Director. LPA toured the facility for Health & Safety inspection. Also present were 5 teachers and 28 children in care. LPA Clayton observed children being handled and supervised appropriately. Both Staff and children were observed wearing masks.

During the investigation LPA Clayton interviewed the Complainant and the Program Assistant assigned to the facility by PACE Early Childhood Education Program.

Based on LPAs interviews and record review(s), the above allegation(s) is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and discussed. Exit interview conducted and report was reviewed with Myra Sabas, Regional Site Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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