<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402633
Report Date: 07/03/2019
Date Signed: 07/03/2019 09:45:06 AM

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:WILSHIRE BOULEVARD TEMPLEFACILITY NUMBER:
197402633
ADMINISTRATOR:CAROL BOVILLFACILITY TYPE:
850
ADDRESS:11661 W. OLYMPIC BLVD.TELEPHONE:
(310) 445-1280
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:182CENSUS: 77DATE:
07/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Carol Bovill - Director TIME COMPLETED:
10:05 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Peter Flores, conducted a Case Management Inspection for the purpose of a Caregiver Background Check Bureau (CBCB) Case Closure.

At 8:50 AM, LPA Flores, met with Facility Security to gain entrance to the facility. At 9:00 AM, LPA was escorted into facility by Security and met with Director Carol Bovill.

The Department received a Case Closure for JOHNSON, ANASTASIA. LPA Flores, inquired about Anastasia Johnson employment. Carol stated that Anastasia Johnson never worked for her facility, but the Temple has all of their employees associated to the Pre-School.

LPA Flores spoke to Cheryl Sander head of Human Resources who stated that Anastasia Johnson worked for the Temple from 01/22/2014 to 01/01/2015, and has not worked at the Temple in the past 5 years.

During this Inspection it is determined with the information provided by the facility that Anastasia Johnson is not employed by the facility at this time.

An exit interview was conducted and a copy of this report was given to Director Carol Bovill.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1