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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 06:53:15 PM

Document Has Been Signed on 02/04/2025 06:53 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: 3DATE:
02/04/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:32 PM
MET WITH:Ebeagbor EmuobonuvieTIME VISIT/
INSPECTION COMPLETED:
04:14 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, greeted the LPA. Dabuet explained that the visit was related to an incident that occurred on January 27, 2025.

On January 29, 2025, Program Supervisor Emuobonuvie reported an incident involving clients #1 through #3 (C1-C3) and staff member #1 (S1), alleging a violation of client rights involving drug possession on January 27, 2025.

During the visit, the LPA interviewed the program supervisor and clients #1-#3. Staff member #1 was unavailable for an interview at that time. The LPA requested copies of Face Sheets and Client Development and Evaluation Reports for clients #1-#3.

An exit interview was conducted with Ebeagbor Emuobonuvie, and a copy of the report was provided.
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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