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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404132
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:12:59 PM

Document Has Been Signed on 10/16/2024 04:12 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/
DIRECTOR:		SILVA DE LA ROSAFACILITY TYPE:
850
ADDRESS:1809 WEST BLVD.TELEPHONE:
(323) 954-8099
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY: 68TOTAL ENROLLED CHILDREN: 69CENSUS: 34DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:LaShaye DavisTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 10/16/2024 Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection due to an incident that occurred on 10/3/2024 and was reported to the Regional Office. LPA met with Lashaye Davis, Regional Site Director and informed the nature of the visit. LPA observed 34 Children in care with proper teacher/child ratios observed. There was a total of 6 staff.

According to the UIR Outside playtime, the children were running around chasing each other when C1 fell hitting her head. C1 got up and walked with Staff (S1). S1 observed a scrape mark and some swelling on the forehead. Staff cleaned the area and applied icepack. Parents were notified and arrived to the facility right away. Parents took C1 to the clinic. Medical provider stated it was okay for C1 to return to the facility on 10/4/2024.

During the investigation LPA Whitmore was only able to interview S1 and C1. LPA Whitmore was able to ask S1 a couple of questions. LPA Whitmore will have to come back to continue with interviews. It was time for S1 to get off, LPA Whitmore did not continue with the interviews. S2 was absent today and could not be interviewed. LPA Whitmore obtained the Roster, Accident/ Incident Report, Doctor’s Note Head Injury Precaution Sheet, & Monthly Attendance.

Based on the interviews and the documents obtained the incident needs further investigation. An exit interview was conducted with Regional Site Director Lashaye Davis. Copy of this report, Notice of Site Visit, & Appeal Rights issued.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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