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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601542
Report Date: 12/12/2025
Date Signed: 12/12/2025 12:54:08 PM

Document Has Been Signed on 12/12/2025 12:54 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:WILKIE HOMEFACILITY NUMBER:
198601542
ADMINISTRATOR/
DIRECTOR:		MARGARITA NUNEZ RENTERIAFACILITY TYPE:
735
ADDRESS:17234 WILKIE AVETELEPHONE:
(310) 538-8599
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 3CENSUS: 3DATE:
12/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Spencer CroasdaleTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 12/12/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit using the full CAREs tool. LPA met with Program Supervisor, Spencer Croasdale, the purpose of today's visit was explained. The facility is licensed for three (3) nan-ambulatory developmentally disabled adults. During the time of visit there were three (3) clients present.
Physical Plant/Structure The facility is a single-story home in a residential neighborhood. The facility consists of three (3) bedrooms, two (2) bathrooms, kitchen, dining room, laundry room, living room, office area, outdoor activity area, and detached garage. The backyard has a shaded patio with a swing, table, and chairs. All walkways outside were observed clean, clear, and free of debris, hazards, and obstructions. All safety handrails were observed secure and in good repair. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all bedrooms and observed they were observed clean and in good repair. LPA observed bedrooms to have the required furniture including a bed, dresser, nightstand, chair, and ample storage space for client’s personal belongings. Beds were observed with the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillow. All linens were observed in good repair. The department observed an adequate supply of linens in good repair. Bedrooms were observed with adequate lighting.
Bathrooms LPA inspected both bathrooms and found them to be within Title 22 Regulations. Bathrooms were observed clean, operable, and in good repair. Showers were observed free of mildew and/or mold. Showers have secured safety handrails, nonskid mats, and shower chairs. LPA observed an ample supply of personal hygiene products secured in the laundry room. The water temperature measured 116.0-degrees and 116.4-degrees Fahrenheit.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 12/12/2025
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Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed an ample supply of cookware, dishware, and cutlery in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly labeled, dated, and stored. All appliances were observed operable. The water temperature measured 116.6-degrees Fahrenheit. LPA observed all sharps secured in a locked cabinet in the laundry room and are inaccessible to clients. LPA observed cleaning supplies secured in a locked cabinet in the laundry room and are inaccessible to clients.
Common Rooms LPA inspected all common rooms and observed the facility to be appropriately furnished. The living room has a couch and three recliners to accommodate all clients. The sitting room has a couch and a chairs to accommodate clients. LPA observed a fireplace screened and not accessible to clients. The dining room has a large rectangular table with chairs to accommodate all clients. LPA observed games, puzzles, and activities stored in the laundry room. The facility was maintained at a comfortable temperature. LPA observed all walkways to be clean, clear, and free of hazards and obstructions. All rooms were observed to have ample lighting.
Medications LPA observed centrally stored medications secured in a locked cabinet in the kitchen and are inaccessible to clients. All medications were observed in their original packaging. LPA reviewed the medications and Medication Administration Records (MARs) for three (3) clients. LPA observed three (3) out of three (3) client’s MARs and medication are consistent with properly documented records.
Files LPA observed files secured in a locked closet in the dining room and are inaccessible to clients and visitors. LPA reviewed three (3) client files and observed the files contain the required documents. LPA reviewed two (2) clients Personal and Incidental (P&I) funds. LPA received and reviewed the Surety Bond through Atlantic Specialty Insurance Company. LPA reviewed the Administrator’s and three (3) staff files and observed they contain the required documents, certification, and training. The Administrator’s Certificate is valid till 10/03/26. LPA reviewed the staff training logs and observed staff have the required training hours and attend training on a monthly basis. During file review, LPA observed Licensing Fees are current.
Safety LPA observed all required signs and documents posted throughout the facility. Smoke detectors and Carbon Monoxide detectors are operable. LPA observed two (2) fully charged fire extinguishers, last serviced on 03/21/2025. The last facility inspection from the Torrance Fire Department was 02/13/2024. LPA inspected the First Aid Kit and found it contained the required items and a manual. The last emergency drill was conducted on 10/13/2025. The facility has a working landline telephone. There are no firearms or ammunition stored at the facility.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 12/12/2025
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Infection Control Upon entry LPA observed a sign-in for visitors and a hand sanitizing station at the front door. The department observed infection control signs posted throughout the facility. The department observed a 60-day supply of Personal Protective Equipment (PPE).

LPA did not observe or cite any deficiencies.

An exit interview was conducted with Program Supervisor, Spencer Croasdale, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC809 (FAS) - (06/04)
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