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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494241
Report Date: 04/11/2024
Date Signed: 04/11/2024 04:24:10 PM


Document Has Been Signed on 04/11/2024 04:24 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: 74DATE:
04/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Nubia Juarez- Regional Site DirectorTIME COMPLETED:
04:35 PM
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On 04/11/2024 at 12:45 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 03/18/2024 and was reported to the Regional Office. LPA met with Nubia Juarez, Regional Site Director and informed the nature of the visit. LPA observed 74 Children in care with proper teacher/child ratios observed. There was a total of 27 staff.

The El Segundo Regional Office received the Unusual Incident/ Injury Report on 03/22/2024. Injury took place on 03/18/2024.The Family Developmental Advocate received an email from mother concerning her child's private area. On 03/19/2024 at 7:00a.m. the Regional Site Director Nubia that her child was complaining about the penile area. Parent looked at her child's penile area and it looked like it was scrape of some sort and the diaper had blood. Parent asked child what happened? Child replied my friend hurt me.

LPA obtained a copy of Doctor's Note from Kaiser Permanente, and Diaper Log. On 04/11/2024 Licensing Program Anayst( LPA) Doris Whitmore went to the playground to check to make sure there were no blind spots of when children are playing. LPA Whitmore moved to different areas of the playground where children would engage in outdoor activities. LPA conducted one file review.LPA Whitmore reviewed file. All documentation that was in the file were the Education and Enrollment Documentation. LPA Whitmore did not see any documentation related to the injury in the file. Regional Site Director Nubia Juarez did give LPA Whitmore a copy of the Doctor's Note. LPA Whitmore interviewed three staff and two children.

At this time further investigation is needed. An exit interview was conducted and a copy of this report along with the Notice of Site Visit was issued to Ivette Leon.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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