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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402062
Report Date: 10/19/2023
Date Signed: 10/19/2023 02:05:46 PM


Document Has Been Signed on 10/19/2023 02:05 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:WILTON PLACE EARLY EDUCATION CENTERFACILITY NUMBER:
197402062
ADMINISTRATOR:RICKY LIMFACILITY TYPE:
850
ADDRESS:4030 LEEWARD AVENUETELEPHONE:
(213) 383-4971
CITY:LOS ANGELESSTATE: CAZIP CODE:
90005
CAPACITY:110CENSUS: 68DATE:
10/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Principal Ricky Lim TIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management inspection today, to follow up on two incidents reported to the department. LPA met with Principal Ricky Lim

First incident was reported on 8/21/2023 and second incident was reported on 9/13/2023. Incidents were reported within the required 24 hours. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days.

LPA Lopez conducted interviews with staff. Incident # 1 occurred off site and appropriate reports were made to required agencies. In regards to incident # 2 LPA conducted interviews with staff and observed area where incident happened. Child slipped while washing hands- incident was observed by staff, first aid was provided and parents were informed. Child did not required medical attention, stay at school the entire day and was back the next day of incident.Per Principal, they reminded staff to make sure the restroom area remains dried throughout the day. .

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when the incident occurred. Therefore, there are no deficiencies being cited. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Principal Ricky Lim.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
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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