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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404132
Report Date: 06/12/2024
Date Signed: 06/12/2024 04:05:10 PM


Document Has Been Signed on 06/12/2024 04:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:PACE - 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: 10DATE:
06/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Amanda Velaswiez- Assistant DirectorTIME COMPLETED:
04:10 PM
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On 06/12/2024 Licensing Program Analyst (LPA) Doris Whitmore and Tyra Chavies conducted an unannounced visit for the purpose of conducting a Case Management Inspection due to an incident that occurred and was reported to the Regional Office on 05/08/2024 by Grace Choi, Program Systems Coordinator. LPA spoke to Assistant Director Amanda Velasquez and informed about the purpose of the visit. There was a total of 10 children and 6 Staff. The UIR Reported that on 05/07/2024 during dismissal Grandma of child, and legal guardian came in with daughter to pick him up. As Grandma signed him out. Teacher ( S3) went to child's cot and pulled child's blanket and put it aside, then held both of child's arms and pulled his arms upward twice, then to a standing position. Child appeared to be unsteady /still sleeping and Teacher( S3) picked child up by his underarms area and carried him over to the children's cubbies by the front door area. ( C1) was absent and staff interviews were conducted.
LPA Whitmore obtained a copy of the Service Contract Summary. LPA'S reviewed the child's file Further investigation is needed at this time.
no deficiencies cited
Exit interview was conducted with Assistant Director Amanda Velasquez

Copy of this report and Notice of Site Visit issued.


SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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