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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418783
Report Date: 07/13/2022
Date Signed: 07/13/2022 01:16:55 PM


Document Has Been Signed on 07/13/2022 01:16 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:WILEY CTR. FOR SPEECH & LANG. DEV., THEFACILITY NUMBER:
197418783
ADMINISTRATOR:VALENTINE, ROSALINDFACILITY TYPE:
840
ADDRESS:5761 BUCKINGHAM PKWY.TELEPHONE:
(310) 649-6199
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:30CENSUS: 0DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Angela Morgan - facility representativeTIME COMPLETED:
12:02 PM
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On 7/13/2022 Licensing Program Analyst (LPA) Chandler made an announced visit to the Wiley Ctr. for Speech and Language Development for the purpose of delivering an amended report. LPA met with Angela Morgan (facility representative).

A copy of this report and the amended report was provided.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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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