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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603257
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:03:59 PM

Document Has Been Signed on 09/14/2023 03:03 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SHAWNTA FAMILY HOMEFACILITY NUMBER:
198603257
ADMINISTRATOR:PLAYER, SHAWNTAFACILITY TYPE:
735
ADDRESS:152 WEST 88TH PLACETELEPHONE:
(562) 618-4057
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY: 4CENSUS: 0DATE:
09/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Shawnta Player - AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Erik Zaragoza met with administrator Shawnta Player regarding an updated fire clearance and change of ambulatory status for the facility. The fire clearance dated 8/21/2023 granted clearance for up to 4 non-ambulatory and ambulatory clients. The purpose of the visit was to inspect the updates to the facility grounds. LPA Zaragoza took a tour of the facility, which included the front entrance, client bedrooms, the shared client bathroom, and backyard.

A transferable wheelchair ramp was observed that can be fitted over the front staircase of the facility which will allow a non-ambulatory client to enter the facility. The front entrance to the facility is unobstructed and has a clear walkway. Administrator placed the ramp in the front steps of the facility to demonstrate that it properly fit over the front staircase. LPA observed that there were grab bars mounted on the walls of the restroom near the toilet as well as outside and inside the shower. The back bedroom of the facility has a set of steps that also have handrails, lead to the other rooms within the facility, and the administrator explained that she is planning to use this bedroom for ambulatory clients only, however she stated that she will be purchasing an extra ramp if needed for non-ambulatory clients to access all areas of the home. The exit door to the backyard from the back room of the facility is unobstructed and would be accessible for non-ambulatory clients.

There are currently no clients that are living in the facility, however LPA advised administrator that the transferable wheelchair ramp needs to be secured over the front steps of the facility at all times once clients are admitted into the facility in the event of an emergency. No deficiencies observed during today's visit, exit interview held and a copy of this report was provided to Shawnta Player.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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