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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191601509
Report Date: 07/18/2022
Date Signed: 07/18/2022 03:00:19 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2022 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20220708160618
FACILITY NAME:HARRY A MIER CENTERFACILITY NUMBER:
191601509
ADMINISTRATOR:LIM, JAE WFACILITY TYPE:
775
ADDRESS:8090 CRENSHAW BLVDTELEPHONE:
(323) 753-3101
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:27CENSUS: 9DATE:
07/18/2022
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Program Supervisor La Niece RandolphTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility air conditioning vent is in disrepair.
INVESTIGATION FINDINGS:
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On 7/18/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint visit at this facility. LPA spoke with staff via telephone prior to entering the facility to conduct risk assessment and was informed that facility has no COVID-19 cases nor do any of the clients have symptoms. LPA arrived at facility and explained the purposed of the visit is to investigate the allegation listed above and was granted access.

The investigation consisted of the following: On 7/18/2022 LPA conducted a tour of facility grounds and reviewed records for staff and clients. LPA conducted interviews with staff (S1-S4), and clients (C1-C4). LPA Cifuentes requested and received the following documents: Client roster, staff schedule and other documents relevant to the investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 11-AS-20220708160618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
VISIT DATE: 07/18/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility air conditioning vent is in disrepair.

The complainant alleges air conditioning vent in bathroom near the pool does not work. LPA toured facility grounds and noted the following: Pool is in a separate building from day program. Pool house is one story with main pool area, staff room and two restrooms, one for women and one for men. LPA observed air-conditioning panel in staff office. LPA observed four air conditioning vents in women’s restroom and three in men’s restroom. LPA could feel that both restrooms were cooler than pool area but was unable to determine if all vents were operating or not. LPA noted that all vents in main building were clean and in good repair. LPA Cifuentes interviewed clients (C1-C4) regarding the allegations. One client was unable to answer questions due to diagnosis and another told LPA that they did not use facility pool or adjacent restrooms. Of the remaining two, one answered that air conditioning vents are working and the final one stated that vents are being repaired. LPA interviewed staff (S1-S4) regarding the allegation. Of those interviewed 2 out of 4 stated they did not know anything about air conditioning vents by the pool, and two stated that the air conditioning was working. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Based on information gathered, the department did not find sufficient evidence to support allegations " Facility air conditioning vent is in disrepair Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 was provided to Program Supervisor La Niece Randolph.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2022 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20220708160618

FACILITY NAME:HARRY A MIER CENTERFACILITY NUMBER:
191601509
ADMINISTRATOR:LIM, JAE WFACILITY TYPE:
775
ADDRESS:8090 CRENSHAW BLVDTELEPHONE:
(323) 753-3101
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:27CENSUS: 9DATE:
07/18/2022
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Program Supervisor La Niece RandolphTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Facility air conditioning vent is dirty.
INVESTIGATION FINDINGS:
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On 7/18/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint visit at this facility. LPA spoke with staff via telephone prior to entering the facility to conduct risk assessment and was informed that facility has no COVID-19 cases nor do any of the clients have symptoms. LPA arrived at facility and explained the purposed of the visit is to investigate the allegation listed above and was granted access.

The investigation consisted of the following: On 7/18/2022 LPA conducted a tour of facility grounds and reviewed records for staff and clients. LPA conducted interviews with staff (S1-S4), and clients (C1-C4). LPA Cifuentes requested and received the following documents: Client roster, staff schedule and other documents relevant to the investigation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20220708160618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
VISIT DATE: 07/18/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility air conditioning vent is dirty.

The complainant alleges that air conditioning vents in bathrooms are dirty. LPA toured facility grounds and noted the following: Pool is in a separate building from day program. Pool house is one story with main pool area, staff room and two restrooms, one for women and one for men. LPA observed air-conditioning panel in staff office. LPA observed four air conditioning vents in women’s restroom. Of the four vents, one had rust stains, one was slightly dusty and the last two were covered in a thick layer of dust. LPA observed 3 vents in men’s restroom and found no dust on any of them. LPA Cifuentes interviewed clients (C1-C4) regarding the allegations. One client was unable to answer questions due to diagnosis and another told LPA that they did not use facility pool or it’s adjacent restrooms. Of the remaining, 2 out of 2 answered that pool bathroom vents are clean. LPA interviewed staff (S1-S4) regarding the allegation. Of those interviewed 2 out of 4 stated they did not know anything about air conditioning vents by the pool, and of the final two, one stated they weren’t sure about the vents and the final one stated they were a little dirty.

Based on information gathered, the department did find sufficient evidence to support allegation " Facility air conditioning vent is dirty.

Based on interviews conducted and records reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.



An exit interview was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Program Supervisor La Niece Randolph
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20220708160618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2022
Section Cited
CCR
82087(a)
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Buildings and Grounds
The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement was not met as evidenced by:
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Facility will have air conditioning vents cleaned and submit proff of correction to LPA CIfuentes via email or fax by POC due date. LPA inspected vents again on 7/18/2022 and noted that they had been cleaned. POC cleared during todays visit.
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On 7/18/2022 LPA toured facility and observed that several of the vents in women's restroom by pool were covered in a heavy layer of dust. This is a potential health risk to the clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5