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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494241
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:09:29 PM


Document Has Been Signed on 03/19/2024 04:09 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 - ALOHA LEARNING CENTERFACILITY NUMBER:
197494241
ADMINISTRATOR:NUBIA JUAREZFACILITY TYPE:
850
ADDRESS:13000 VAN NESS AVENUETELEPHONE:
(424) 340-2640
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:92CENSUS: 71DATE:
03/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Nubia Juarez- Rewgional Site DirectorTIME COMPLETED:
04:30 PM
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On 03/19/2024 at 12:17 p.m. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection due to an incident that occurred on 02/02/2024 and was reported to the Regional Office. LPA met with Nubia Juarez, Regional Site Director and informed the nature of the visit. LPA observed 71 Children in care with proper teacher/child ratios observed. There was a total of 15 staff.

LPA obtained a copy of sign in sheets, School Status Report from Kaiser Permanente, Accident/ Incident Report, & Doctor’s Note. LPA conducted a record review of child1 file.

On 02/02/2024 Class 01 indoors, (due to rainy weather). C1 was doing indoor music and movement on the carpet when he ran off the carpet on the floor and fell flat on floor, hitting his left hand on the floor. C1 complained of pain. On 02/06/2024 during drop- off parent of C1 mentioned child was still experiencing minor pain. Parent of C1 took child to Southern California Kaiser Permanente Medical Group. LPA Whitmore interviewed Regional Site Director Nubia Juarez and Teacher Rudolfo Tejeda Child 1 diagnosis was a sprained finger and could return to the facility with no restrictions. An exit interview was conducted with Regional Site Director Nubia Juarez. Copy of this report, Notice of Site Visit, Appeal Rights issued.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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