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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404133
Report Date: 02/14/2023
Date Signed: 02/14/2023 03:41:42 PM


Document Has Been Signed on 02/14/2023 03:41 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:PACE HEAD START-CHRISTIAN FELLOWSHIPFACILITY NUMBER:
197404133
ADMINISTRATOR:CARLOS BELLOFACILITY TYPE:
850
ADDRESS:2085 SO. HOBARTTELEPHONE:
(323) 766-0722
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:41CENSUS: 14DATE:
02/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Silvia De La RosaTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) T. Tran arrived at PACE Christian Fellowship Head Start to conduct a Case Management inspection that was self-reported on 01/27/2023 regards an enrolled child's personal rights concern. Upon arrival, LPA met with Silvia De La Rosa, Lead Teacher then we toured the facility indoor and outdoor. LPA observed proper care and supervision and ratio.

File review was conducted. LPA obtained child’s document, facility roster, and personnel report. LPA interviewed with staff and children. Due to insufficient information available at this time, the above allegation need further investigation.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Silvia De La Rosa.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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