<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601509
Report Date: 09/16/2025
Date Signed: 09/17/2025 06:53:42 AM

Document Has Been Signed on 09/17/2025 06:53 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
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: 30DATE:
09/16/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Jae LimTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Case Management visit. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the evaluation, the facility is clear of COVID-19 infection. LPA Bunker met Center Director Jae Lim and explained that the purpose of today's meeting was to review a plan of operation addendum regarding items to be considered for temporary emergency shelter.

The facility is licensed to serve fifty (50) ambulatory and four (4) non-ambulatory clients aged 18 through 59. At the time of today's visit, there are 30 clients present. The facility has a 13 ratio. The Adult Day Program annual fees are current.

The Adult Day Program is located in a single-story commercial business area, operating hours are 9:00 A.M. to 6:00 P.M., 5 days a week, Monday through Friday. All clients bring their own lunch or bring money to purchase lunch in the community. If clients forget their lunch, the facility staff will provide emergency food for clients.

The day program is a single-story structure located in a commercial building. Mr. Lim and LPA Bunker toured the entire Adult Day Program inside and out which consisted of the following: The Day Program consists of the following: Lobby, reception area, 5 administrative offices, two (2) activity rooms, medication/first aid room, commercial kitchen, conference room, mail room, staff lounge, seven (7) client restrooms and two (2) staff restrooms, 2 restrooms, and pump room, storage garages, and an outside shaded area with a gated parking lot.
See continued LIC809-C on page #2
NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Pamela Bunker
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
VISIT DATE: 09/16/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued LIC809-C page #2

There is an indoor pool on the grounds, with an office, outside of the gated area in a detached building inaccessible to residents. A lifeguard is present during operating hours, and doors are securely locked. The clients do have activities in the pool throughout the week, such as water aerobics.

All areas are in compliance. Each room is adequately equipped and furnished. The staff in-service training was reviewed. The employee personnel files and client records are in a locked cabinet in the administrative office and were reviewed and appear to be in compliance. Ms. Lim states that staff were given training on dependent adult and elder abuse reporting videos. The day program currently has two clients on medication. The medications are in a locked cabinet in the medication room. There are no personal/incidental monies handled by the day program staff. The last Fire/Emergency Drill was conducted on September 09, 2025

During the visit, LPA observed the facility's infection control practices. LPA reviewed the screening protocol for visitors, staff, and clients. There are sanitizing stations in common areas and restrooms. LPA observed that the facility has a 90-day supply of Personal Protective Equipment (PPE).

Documents are posted as mandated in the program activity rooms. The following Title 22 regulated areas were audited and found to be in compliance: Hot water temperature measured at 113.8 degrees Fahrenheit, carbon monoxide and smoke detectors were in compliance, fire extinguishers are fully charged, rest-rooms are clean and operational, and toxic/sharp items are locked and inaccessible to clients. Hazardous items are inaccessible to clients, and the first aid kit is fully stocked with a manual. The day program grounds are free of debris/hazards.

The Following Plan of Operation addendum items to be considered for a temporary emergency shelter:
  • The ADP Emergency Disaster would activate the durable accommodation concept.
  • The ADP Licensee is in compliance.
  • The Regional Office conducted a Case Management (CM) visit to identify the feasibility of conversion from an ADP to a temporary shelter.
  • The ADP needs to submit an addendum to the plan of operation to the Regional Office.
See continued LIC809-C page 3
NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Pamela Bunker
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
VISIT DATE: 09/16/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued LIC809-C page 3

Items that should be addressed on the addendum of the Plan of Operation:
  • Notification to the Fire Department regarding the change of clientele and time of operation in the event of an emergency disaster
  • Notification procedure to the Regional Office (RO) once the durable accommodation concept is activated
  • Identify the maximum number of residents that can be accepted at the ADP location
  • Identified clientele that will be served
  • Notification procedure to existing ADP participants on closure of the day program during an emergency disaster, and alternate means to provide services to these attendees
  • Procedure on how the ADP converted shelter would be staffed-ADP staff, Residential Staff, or a combo, distinguishing who would be in charge of assistance with medications, identification of the designated lead of the site, and chain of command communication between the site lead and the residential site leads, including who would report any incident reports when they occurred on site at the ADP.
  • Notification process to the home health or hospice agency
  • Identify a 24/7 contact person and phone number so it can be provided to the residents' responsible persons
  • The ADP needs an Emergency generator
  • Shower with grab bars
  • Toilets with grab bars, pull cords
  • ADP is to have cots/beds, bed linen, and wash cloths/towels kept on site?
  • Alternate locations where cots/beds, bed linen, and wash cloths/towels are kept
  • Identify transportation means to transport cots/beds, bed linen, and wash cloths/towels if stored offsite, including the length of time needed to get these items to the ADP
  • Needs for portable toilet rental
  • Means to receive portable toilets
  • Will the ADP furnish adult briefs and other incontinence-related supplies
  • Will ADP Supplies of drinking water

See continued LIC809-C page 4
NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Pamela Bunker
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HARRY A MIER CENTER
FACILITY NUMBER: 191601509
VISIT DATE: 09/16/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued LIC809-C page 4
  • Proposed means for food services - food caterers, cook on site - kitchen equipment
  • Responsibility to transport any durable medical equipment - Oxygen concentrator, etc.
  • Responsibility to transport Grab Bags and medications from the residential home to the ADP
  • The necessity to discuss with the insurance agency or the landlord

The items listed above must be completed before a temporary emergency shelter can be considered and approved for use.

There were no deficiencies cited. An exit interview was conducted.
NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Pamela Bunker
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5