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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419605
Report Date: 05/08/2019
Date Signed: 05/13/2019 02:31:48 PM

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-EARLY EXPLORERS HEAD STARTFACILITY NUMBER:
197419605
ADMINISTRATOR:MARTHA HERNANDEZFACILITY TYPE:
850
ADDRESS:1200 S. MANHATTAN PLACETELEPHONE:
(213) 989-3244
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:21CENSUS: 16DATE:
05/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Aracely Sanchez/Lead teacherTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst (LPA), Silva Garibyan, met with the lead teacher upon arrival to the facility. LPA conducted the visit for the purpose of following up on an Unusual Incident report received in the Regional office on 04/11/19 (incident occurred on 04/10/2019). According to this report: " On April 10, 2019 at 8:30 during outside time child was going up steps on slide structure, and slipped and hit himself under chin. Child was taken care of by teacher, and mom was on site (volunteering) she was called to come outside. Teachers advised her to take child to urgent care, and mom agreed. On 04/10/2019 mom took child to doctor and child received four stitches. Dr. advised child to stay out of school for two days."
LPA inspected the play structure and observed the area where the child fell. The equipment was observed to be in good repair. The structure is age appropriate based on the manufacturer's recommendation.

LPA interviewed Staff #1 and Child # 1. Staff #1 was supervising the children at the time of the incident. Per Staff #1 statement; at the time of the incident, there were one teacher and one aide with a maximum of 18 children. Child#1's mother (parent volunteer) was in the classroom. Staff #1 pointed where she was standing, which was not close to equipment. According to Staff #1, she had visual observation when child fell, but she wasn't close enough to catch Chld #1. The visual supervision of the slide structure was lacking.

Facility was cited type B deficiency See Facility Evaluation Report LIC 809D for deficiencies cited.

A copy of this report was provided to the lead teacher and an exit interview was conducted.



SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PACE-EARLY EXPLORERS HEAD START
FACILITY NUMBER: 197419605
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2019
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time
This requirement is not met as evidenced by:
A child was injured while playing in the play yard and received four stitches. The teacher was present in the play yard but was not standing close to equipment.
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Director must conduct a staff meeting that addresses supervision of children in care This meeting is to be conducted by 05/15/2019.

Director will provide an agenda of the topics discussed, and a sign in sheet of all employees who will attend the meeting.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
LIC809 (FAS) - (06/04)
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