197494241-9-25-2024-30-CC-DWHE-D9FVFK-20240925162404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494241
Report Date: 09/25/2024
Date Signed: 09/25/2024 04:24:08 PM

Document Has Been Signed on 09/25/2024 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 CENTER		FACILITY NUMBER:	197494241
ADMINISTRATOR/ DIRECTOR:	NUBIA JUAREZ		FACILITY TYPE:	850
ADDRESS:	13000 VAN NESS AVENUE		TELEPHONE:	(424) 340-2640
CITY:	GARDENA	STATE: CA	ZIP CODE:	90249
CAPACITY: 92	TOTAL ENROLLED CHILDREN: 85	CENSUS: 18	DATE:	09/25/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:50 PM
MET WITH:	Nubia Juarez- Regional Site Director		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

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On 09/25/2024 at 1:50p.m.. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection due to an incident that occurred on 08/30/2024 and was reported to the Regional Office on 09/10/2024. LPA met with Nubian Juarez, Regional Site Supervisor and informed the nature of the visit. At the time of the visit there was only 5 children and 2 teachers for Headstart. For Headstart there were 13 children and 3 teachers.

According to the UIR Child#1 was playing outside on the playground area running towards the ball and trying to kick the ball. He ended up tripping over his own feet and hit his head on the concrete ground. He sustained a little bump to the head with a scrape with no bleeding. He also was observed with scrapes on his right knee and left hand elbow. Teacher observed and applied ice pack to his head. The parents were called and picked up child right away. Parents were asked inform staff if the child was going to the doctor. The child was taken to the doctor. The child was taken to the doctor on the same day. Parents notified staff after labor day on 09/4/2024. The child has not returned back to the facility since the injury.

S1 was able to demonstrate How C1 hit his head. LPA Whitmore was unable to Interview S2 who was at another location and was providing support the day of the incident on 08/30/2024. LPA Whitmore reviewed C1 file and a copy of the Accident/ Incident Report was in the file. LPA Whitmore obtained the following copies Sign in Sheets for 08/30/2024, Doctor's Note, Facility Roster, and Monthly Attendance, Accident/ Incident Report Head Injury. C1 returned back to school on 09/23/2024 with a clearance from the doctor

During the investigation LPA Whitmore interviewed one teacher. At the time of the visit C1 mom was picking him up. LPA Whitmore was unable to interview the child.

Based on the information obtained further investigation is needed.

Copy of report and Notice of Site Visit was issued to Regional Site Director Nubia Juarez

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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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