197404132-2-27-2023-30-CC-KSTS-CPG2Y5-20230227164809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197404132
Report Date: 02/27/2023
Date Signed: 02/27/2023 02:57:38 PM

Unsubstantiated

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
11/29/2022 and conducted by Evaluator Doris Whitmore

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20221129090105

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: 22	DATE:	02/27/2023
		UNANNOUNCED	TIME BEGAN:	01:30 AM
MET WITH:	Nubia Juarez		TIME COMPLETED:	02:48 PM

ALLEGATION(S):

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Allegations:
Personal Rights – Staff treats child differently from other children
Lack of Supervision – Staff are not properly supervising children in care
Qualifications – Facility does not have a Director

INVESTIGATION FINDINGS:

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On 02/27/2023 at 1:30p.m. Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced visit for the purpose of delivering findings for a complaint investigation into the above allegations. LPA met with Nubia Juarez and Onice Ming.LPA observed 12 staff and 22 children in care at the time of the Visit.
On 01/25/2023 Licensing Program Analyst Doris Whitmore met with Regional Site Directors Nubia Juarez and Irma Martin, who is here every Thursday. LPA observed a total of thirty-eight children with eight staff upon arrival. During the inspection LPA toured the facility and interviewed staff, Regional Site Director, & one child. LPA obtained the following documents, updated Personnel Report, Service Contact Summary, PACE, Complaint Form, Sign in Sheets, & supporting documentation. LPA reviewed one child’s file and staff files.
On 12/6/2022 Licensing Program Analyst Doris Whitmore met with Nubia Juarez Regional Site Director LPAobserved twenty-three children with ten staff upon arrival. During the inspection LPA toured the facility and interviewed staff, children, & Regional Site Director obtained sign-in sheets, Care & Supervision Policies, Personnel Report, Facility Roster, Daily Schedule, Parent Handbook, Documentation of Qualifications and supporting documentation. LPA interviewed the staff, and children.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

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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Control Number 30-CC-20221129090105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - WEST BOULEVARD	FACILITY NUMBER: 197404132
	VISIT DATE: 02/27/2023

NARRATIVE

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The Department conducted a full investigation, which included staff interviews, interviews of relevant parties, record review which included documentation as related to the allegation, With the information obtained and interviews conducted the investigation did not provide sufficient evidence to substantiate the allegation of Personal Rights, Lack of Supervision, & Qualifications. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are deemed unsubstantiated.

No deficiencies cited. An exit interview was conducted, a copy of this report, appeal rights and Notice of Site Visit were issued.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC9099 (FAS) - (06/04)

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