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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601509
Report Date: 02/23/2022
Date Signed: 02/23/2022 11:16:59 AM

Document Has Been Signed on 02/23/2022 11:16 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
191601509
ADMINISTRATOR:LIM, JAE WFACILITY TYPE:
775
ADDRESS:8090 CRENSHAW BLVDTELEPHONE:
(323) 753-3101
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 27CENSUS: 7DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Program Supervisor La Niece RandolphTIME COMPLETED:
11:25 AM
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On 2/23/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA spoke with staff via telephone to conduct the covid-19 screener questionnaire and was informed the facility is free of Covid-19. LPA met with Program Supervisor La Niece Randolph and explained the purpose of today’s visit is to complete and infection control focused annual. The facility is licensed to serve (23) ambulatory and (4) non-ambulatory clients ages 18-59.

The day program is a single-story structure located in a commercial building. Facility grounds consist of the following: Lobby, administrative offices, physical activity room, arts and crafts room, life skills, first aid room, commercial kitchen, staff break room, copy room and (4) restrooms.

Common areas such as bathrooms and activity rooms were observed to be neat, clean, and properly furnished.

LPA and Program Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. Fire extinguishers are fully charged.

During the visit, LPA observed the facility infection control practices. LPA observed the facility infection control practices. LPA reviewed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms, temperature and symptom logs for clients and staff as well as surveillance testing . LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted and available.

No deficiencies were cited during this inspection visit.

Advisory Notes - Technical Assistance was issued, please see LIC9102-A.

An exit interview was conducted, and a hard copy of this report was provided to Program Supervisor La Niece Randolph.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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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