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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410785
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:47:19 AM

Document Has Been Signed on 01/14/2025 11:47 AM - 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: 45CENSUS: 26DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:54 AM
MET WITH:Debbie KajwajiTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 01/14/2025 at 8:54a.m. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection follow up 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. At the time of the visit there were a total of 26 children and 4 teachers.

LPA Whitmore interviewed two children (C1) and (C2)

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.

(S1) stated that she was in the backroom and what she saw ( C1)was already on his knees he had already fell.( S1) was in the back of the room with another child.

( S2) stated It happened during clean up time, I walked around, and I was talking to the children by the carpet area. I walked to the table area, and all of a sudden, I saw (C1) in a glance he fell. Then we assessed the child(S1) was with (C1) and I was with the other children. I stayed with the kids. After the first aid (S1) called the parent to inform her about the incident. We called it in and then during dismissal the parent was notified again and received the incident report and head injury form.



(C1) was taken to the doctor on 11/22/2024 and returned back to school on 12/3/2024 with a doctor's note and no restrictions.

Based on the information obtained there were no violations of Title 22 Regulations and no lapse of Care and Supervision.
No deficiencies cited
Copy of report and Notice of Site Visit was issued to Debbie Kahwaji

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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