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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494093
Report Date: 08/25/2023
Date Signed: 08/25/2023 04:23:06 PM

Document Has Been Signed on 08/25/2023 04:23 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PACE - FIRST STEPSFACILITY NUMBER:
197494093
ADMINISTRATOR:BELLO, CARLOSFACILITY TYPE:
830
ADDRESS:14420 CRENSHAW BLVDTELEPHONE:
(424) 266-9688
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 2DATE:
08/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Carlos BelloTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA), V. Wheatley conducted a case management inspection regarding an incident that occurred on July 28, 2023. The incident was reported to the Department with regard to Child #1 being injured. LPA observed two children on the premises upon arrival today.

LPA met with Director Carlos Bello who stated that Child #1 was injured on the outdoor play equipment however no medical treatment was administered. Director states that there were several staff member on the yard supervising. LPA interviewed Staff #3 and Staff #4 regarding the supervision of the child. Staff #1 and Staff #2 are not on the premises at this time. Staff #1 witnessed the incident and completed an injury / accident report and Staff #2 provided the ice pack for the child. The child stayed on the premises for the remainder of the day until the parents picked up the child. The parents were provided an incident report. There was no bruises and the child was not taken to the doctor. The child returned to school the next day.

Based on information obtained the supervision was adequate. There were four adults supervising 5 children that were playing outdoors on the yard. There are no deficiencies being cited. LPA inspected the outdoor play equipment and did not observe any hazards.

Exit interview. Report provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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