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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494241
Report Date: 10/02/2024
Date Signed: 10/02/2024 01:32:04 PM

Document Has Been Signed on 10/02/2024 01:32 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 CENTERFACILITY NUMBER:
197494241
ADMINISTRATOR/
DIRECTOR:		NUBIA JUAREZFACILITY TYPE:
850
ADDRESS:13000 VAN NESS AVENUETELEPHONE:
(424) 340-2640
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 14DATE:
10/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:38 AM
MET WITH: Nubia Juarez-Regional Site DirectorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On 10/02/2024 at 10:38 a.m. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for following up on 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 Director and informed the nature of the visit to continue with interviews. At the time of the visit there was only 55 children and 14 teachers. LPA Whitmore was unable to interview C1 because he was absent. After conducting Interviews and reviewing documentation there was no lapse of Care of Supervision for the incident that occurred on 08/30/2024. A Type B was given to the Facility for Reporting Requirements. Please see the D- Page.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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Document Has Been Signed on 10/02/2024 01:32 PM - It Cannot Be Edited


Created By: Doris Whitmore On 10/02/2024 at 12:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PACE - ALOHA LEARNING CENTER
FACILITY NUMBER: 197494241

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2024
Section Cited
CCR
101212(d)(1)(b)

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(d)Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information
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Incident happened on 08/30/2024 and was reported on 09/10/2024. Licensee will report Unusual Incident Reporting in a timely Manner.


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specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
1) Events reported shall include the following:
(B) Any injury to any child that requires medical treatment.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karren Starks
LICENSING EVALUATOR NAME:Doris Whitmore
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
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