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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602276
Report Date: 04/22/2024
Date Signed: 04/22/2024 04:57:35 PM

Document Has Been Signed on 04/22/2024 04:57 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/
DIRECTOR:		JOHNSON, SHYLEE ROSHAYFACILITY TYPE:
735
ADDRESS:21908 S VERMONT AVETELEPHONE:
(424) 358-1512
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 6CENSUS: 2DATE:
04/22/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:31 PM
MET WITH:Barbara TurnerTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 04/22/2024 at 3:31 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced subsequent annual inspection to the above-named facility and met with House Manager Barbara Turner. LPA Cloyd explained the purpose of the visit.

Five (5) staff records were reviewed, 5 out of 5 staff records had had required criminal record clearances or criminal record exemptions.

No deficiencies cited.

An exit interview was conducted, technical assistance provided and a copy of this report was discussed and left with the House Manager Barbara Turner.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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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