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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601542
Report Date: 02/26/2024
Date Signed: 02/27/2024 08:08:25 AM

Document Has Been Signed on 02/27/2024 08:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:WILKIE HOMEFACILITY NUMBER:
198601542
ADMINISTRATOR:MARGARITA NUNEZ RENTERIAFACILITY TYPE:
735
ADDRESS:17234 WILKIE AVETELEPHONE:
(310) 538-8599
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 3CENSUS: 3DATE:
02/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Yanett AguilarTIME COMPLETED:
04:00 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 02/26/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a case management visit to the facility listed above. LPA met with Program Director, Yanett Aguilar, and the purpose of today's visit was explained. During today's visit all three (3) clients were present.
LPA conducted a case management visit today to follow up on a Special Incident Report (SIR) submitted to Community Care Licensing (CCL) on 02/23/24. The SIR states that during a clients behavioral episode, in January 2024, staff grabbed a client from behind roughly and staff took the client into their room. There was no additional details provided regarding the incident. The report of the incident was made on 02/21/24 via the company's Compliance Hotline. The SIR was submitted by the Operations Management Regional Director.
During today's visit, LPA toured the facility, interviewed staff and clients, and received Special Incident Reports submitted to Community Care Licensing (CCL). During an interview with the Program Director, they were unaware of the incident that was reported, and unaware of the SIR submitted to CCL.
During today's visit no deficiencies were observed or cited.
An exit interview was conducted with Program Director, Yanett Aguilar, and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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