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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404132
Report Date: 02/21/2020
Date Signed: 02/21/2020 11:53:21 AM

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: 39DATE:
02/21/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marlia Figueroa, Lead TeacherTIME COMPLETED:
09:30 AM
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On 02/21/2020 at 08:30 am, Licensing Program Analyst (LPA) Sabrina Martinez arrived at PACE Head Start-West Boulevard located at 1809 West Blvd., Los Angeles, CA 90019 for the purpose of a case management visit.

LPA met with Marlia Figueroa, Lead Teacher, to deliver the report from the Case Management-Incident Inspection conducted on 02/18/2020.

On 02/18/2020, LPA Martinez's state work computer was inoperable due to a consistency check hence, an electronic report could not be completed at the time of the inspection.

During this inspection, LPA Martinez provided Ms. Figueroa with the LIC 809 (Facility Evaluation Report) dated 02/18/2020 along with the Notice of Site Visit.


An exit interview was conducted and a copy of this report, appeal rights along with the 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: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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