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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320206
Report Date: 02/04/2025
Date Signed: 02/04/2025 06:54:44 PM

Document Has Been Signed on 02/04/2025 06:54 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:234TH HOMEFACILITY NUMBER:
198320206
ADMINISTRATOR/
DIRECTOR:		BOATNER, VERRETTAFACILITY TYPE:
735
ADDRESS:160 E. 234TH STREETTELEPHONE:
(310) 872-3326
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 4CENSUS: 4DATE:
02/04/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:49 PM
MET WITH:Ebeagbor EmuobonuvieTIME VISIT/
INSPECTION COMPLETED:
04:04 PM
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On February 4, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced case management visit at the facility. The program supervisor, Ebeagbor Emuobonuvie, welcomed the LPA. Dabuet explained that the visit was in response to an incident disclosed by Client #4 during a previous visit on December 19, 2024.

During the December 19th interview, Client #4 mentioned that (C4) had received tattoo services at the facility earlier in the year while in care at this facility.

During this visit, the LPA interviewed the program supervisor and Clients #1 through #3. The LPA also requested copies of the face sheets and Client Development and Evaluation Reports for these clients.

An exit interview was conducted with Ebeagbor Emuobonuvie, and a copy of the report was provided to her.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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