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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602276
Report Date: 10/03/2022
Date Signed: 09/09/2024 08:34:59 PM

Document Has Been Signed on 09/09/2024 08:34 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:NEW BEGINNINGS RESPITE CARE LLCFACILITY NUMBER:
198602276
ADMINISTRATOR:JOHNSON, SHYLEE ROSHAYFACILITY TYPE:
735
ADDRESS:21908 S VERMONT AVETELEPHONE:
(424) 358-1512
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 6CENSUS: 3DATE:
10/03/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Barbara Turner TIME COMPLETED:
11:16 AM
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On 10/02/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. Upon arrival, LPA conducted a risk assessment. LPA spoke with House Manager (HM) Barbara Turner who confirmed the facility has no COVID activity. Turner contacted administrator Shylee Johnson by phone but could not attend the visit. LPA explained the purpose of the visit is to conduct a health and safety inspection.

On 09/30/22, Johnson self-reported an incident 09/27/22 with client #1 (C1) for an alleged violation of rights. A health and safety inspection was conducted by LPA Dabuet, including a review of the facility's physical plant and food supply. Interviews were conducted with clients #1 - #2 (C1-C2) and staff #1 (S1). It was not possible to interview Client #3 (C3) because he was on an outing with his family.

As part of this inspection, LPA gathered service records for (C1) and contact information for Harbor Regional Center's representative.

An exit interview was conducted with Barbara Turner and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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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