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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601509
Report Date: 02/21/2025
Date Signed: 03/21/2025 02:41:38 PM

Document Has Been Signed on 03/21/2025 02:41 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:HARRY A MIER CENTERFACILITY NUMBER:
191601509
ADMINISTRATOR/
DIRECTOR:		LIM, JAE WFACILITY TYPE:
775
ADDRESS:8090 CRENSHAW BLVDTELEPHONE:
(323) 753-3101
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 54CENSUS: 24DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Jae Lim, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 02/21/2025 at 8:08am, Licensing Program Analysts (LPA) Zina Brown arrived at the facility. At 8:35am LPA made an unannounced visit to the above facility and explain the purpose of today's visit was to conduct an annual inspection of the facility. On today's visit LPA met with facility Program Director Jae Lim. The facility profile shows that the facility is licensed for a capacity of 54 to serve developmentally disable adults ages 18 thru 59 years, ambulatory and four (4) non-ambulatory only. The Program Director stated that the facility has (54) clients currently enrolled in the program: (49) ambulatory and (5) non-ambulatory. The staff to client ratio is (1) one staff to (3) three clients in the morning program and (1) one staff to (7) seven clients in the afternoon program. The Program Supervisor stated one (1) of the clients have restricted health care conditions and one (1) client utilize any protective devices.

The last disaster drill was conducted 01/28/2025 and a Disaster Plan was on file. The last inspection held by the fire department was on November 2024. The program does provide transportation. The facility fees is for the amount of $303 due on February 24, 2025. LPA provided pin #619391 with the option for the facility to make a payment online.

Between the hours 9:00 am - 11:30am of LPA reviewed (10) client records, (10) staff records, (2) Medication Administration Records and inspected the physical plant. This is a day program located in one large building consisting of the following: gated parking lot(drop off/pick up area), lobby/receptionist area, 2 classrooms, a commercial kitchen (water tested at 112.6), storage area with a washer and dryer, a medication/first aid room, 5 administrative offices, staff lounge area, a mailroom, 7 bathrooms(men’s, women’s and unisex), outside shaded area, garden area, and indoor pool.

Report continues on LIC 809-C.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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Document Has Been Signed on 03/21/2025 02:41 PM - It Cannot Be Edited


Created By: Zina Brown On 02/21/2025 at 02:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above for 2 out of 10 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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The program director will submit proof Physician's Report with ambulatory status and tuberculosis result for the 2 out of 10 clients (Client #3 and Client #4) to the department by the POC Due Date listed above via email at zina.brown@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Zina Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
VISIT DATE: 02/21/2025
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Between the hours 12:00pm - 12:30pm of LPA conducted a tour of the physical plant and observed the following: walls and floors were in good condition, adequate lighting and fire extinguishers were properly charged. LPA observed plenty of storage space and chemicals were properly locked. The restrooms were clean and within Title 22 regulations. The kitchen was clean and a refrigerator was available for client use. The day program does not provide lunch however snacks were available to clients. The first aid kit was available and fully stocked; medications were locked and inaccessible to clients. Walkways throughout the day program and all exits were clear of hazards and debris.

LPA observed the following not in compliance:
On 02/21/2024, LPA reviewed client files and did not observe the following:
  • 2 out of 10 clients did not a health screening.
  • 7 out of 10 clients did not have a Individual Program Plan (IPP).


A deficiency & a Technical Violation were cited Under California Code of Regulations Title 22, Division 6, Chapter 3.

Exit interview conducted and a copy of the appeal rights were given.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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