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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402633
Report Date: 12/15/2021
Date Signed: 12/15/2021 01:55:17 PM

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:
(424) 208-8900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:205CENSUS: 203DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Carol Bovill, Director TIME COMPLETED:
02:00 PM
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
On 12/15/2021 at 11:15AM, Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced case management - Incident, at Wilshire Boulevard Temple located at 11661 W. Olympic Blvd, Los Angeles, CA 90064 for the purpose of following up on the unusual incident that was reported via email by the facility on 11/06/2021. The facility contacted the The El Segundo Child Care Regional Office via phone on 12/07/2021. LPA met with Director Carol Bovill. There are 203 children present with 24 teachers and Director.
According to the report, on 12/01/2021, at 1:05pm, Child#1 was climbing up the steps of the structure and turned around and jumped off landing on his wrist, ice pack it was applied on child’s wrist. The child's parents were notified via phone call and immediately arrived to pick up the child. The child was taken to the urgent care and next day to the orthopedist that confirmed the broken wrist and placed a cast on child’s arm/wrist.
During this inspection, LPA conducted interviews with facility staff and the child involved. LPA toured the facility yard and observed it to be free of holes, broken glass and other debris that could pose a hazard. The playground equipment is securely anchored to the ground and is maintained in a safe condition, free of sharp, loose or pointed parts and observed the label of the age appropriate of the equipment.
LPA reviewed staff#1 and #2 record, that it was completed. LPA also obtained a copy of the sign in and sign out sheet dated 12/01/2021, children’s roster and Personnel Record.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 TEMPLE
FACILITY NUMBER: 197402633
VISIT DATE: 12/15/2021
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
26
27
28
29
30
31
32
Based on the information obtained, it does not appear that this incident was the result of a Title 22 violation for lack of care and supervision. Although the child sustained an injury, staff #1 visually observed the incident and immediately applied ice on the child’s wrist. Parents were also notified immediately.

An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Carol Bovill, Director.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2