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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494241
Report Date: 05/21/2024
Date Signed: 05/21/2024 03:11:18 PM

Document Has Been Signed on 05/21/2024 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 - 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: 76DATE:
05/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Nubia Juarez- Regional Site DirectorTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On 05/21/2024 at 1:00 p.m. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection due to an incident that occurred on 04/19/2024 and was reported to the Regional Office. LPA met with Nubia Juarez, Regional Site Director and informed the nature of the visit. LPA observed 76 Children in care with proper teacher/child ratios observed. There was a total of 17 staff.

According to the UIR, on 04/19/2024 at approximately 9:45 a.m. C1 was playing outside on the playground when he kicked the ball, missed, and lost his balance causing him to fall to the ground and hit the back of his head. S1 stated there was no bleeding, just a small bump on the upper backside of his head and a small scrape. C1 seemed fine, S1 provided C1 with an icepack and notified parents. C1 was picked up by his sister mom was at work.

During the investigation LPA Whitmore interviewed S1 , S2 & C1. LPA Whitmore visited the playground and S1 and S2 were able to show LPA Whitmore where C1 fell. LPA Whitmore reviewed C1 file. LPA Whitmore obtained a copy of Accident/ Incident Report and Head Injury Precaution Sheet. Parent did not take C 1 to the doctor,

Based on the information obtained there were no violations of Title 22 Regulations.


No deficiencies cited
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: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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