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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410785
Report Date: 12/18/2024
Date Signed: 12/18/2024 03:11:14 PM

Document Has Been Signed on 12/18/2024 03:11 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 - ST. JOHN HEAD START CENTERFACILITY NUMBER:
197410785
ADMINISTRATOR/
DIRECTOR:		LYDIA VARGASFACILITY TYPE:
850
ADDRESS:14517 CRENSHAW BLVD.TELEPHONE:
(424) 456-4889
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 45TOTAL ENROLLED CHILDREN: 49CENSUS: DATE:
12/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:17 PM
MET WITH:Debbie Kahwaji- Regional Site DirectorTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 12/18/2024 at 1:17p.m..Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection due to an incident that occurred on 11/20/2024 and was reported to the Regional Office. LPA met with Debbie Kahwaji, Regional Site Director and informed the nature of the visit. LPA observed 9 childrern in care with proper teacher/child ratios observed. There was a total of 2 staff.

According to the UIR, on 11/20/2024 (C1) tripped and fell and when he fell, he hit his left eye on the table. Teachers applied an ice pack and parent was called. On 11/22/2024 mom called saying that his eye is still swollen and will take child to the doctor.

During the investigation LPA Whitmore interviewed ( S1) and ( S2). LPA Whitmore obtained a copy of the doctors note, Incident Report,& Head Injury Precaution Sheet. 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 Debbie Kahwaji

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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