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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198201097
Report Date: 08/31/2022
Date Signed: 08/31/2022 11:12:46 AM

Document Has Been Signed on 08/31/2022 11:12 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:HARRISON'S BOARD & CARE HOMES,INC.FACILITY NUMBER:
198201097
ADMINISTRATOR:ANABELLE HARRISONFACILITY TYPE:
735
ADDRESS:20108 BELSHAW AVENUETELEPHONE:
(310) 554-4210
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 6CENSUS: 5DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Anabelle HarrisonTIME COMPLETED:
11:15 AM
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
On 8/31/22, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced site visit for the annual inspection, with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA Scott met with administrator Anabelle Harrison and the purpose of the visit was explained. LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection. LPA was properly screened for Covid-19 symptoms and temperature was checked and logged in the visitors log in book.

The facility is in a residential area. A tour of the single-story facility includes: Kitchen, dining room, living room, 3 client bedrooms, 1 staff bedroom, 2 bathrooms (1 bathroom for clients and 1 bathroom for staff), attached garage which houses washer and dryer machines (not accessible to clients). During the tour, LPA observed the facility’s infection control practices. LPA did observe a sanitizing station and visitors log book at the facility entrance. PPE supplies are readily available to staff, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is in the front living room. LPA observed staff, and residents maintain 6 feet physical distancing, and staff were wearing a face covering. Residents were going to their day program as I was entering the facility; and they were wearing masks as well. LPA observed the required covid posting throughout the facility.



REPORT CONTINUES IN LIC 809C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HARRISON'S BOARD & CARE HOMES,INC.
FACILITY NUMBER: 198201097
VISIT DATE: 08/31/2022
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
Additionally, LPA observed the following: All outdoor and indoor passageways are kept free of obstruction. There are no pools and bodies of water on the premises. There are no firearms and other dangerous weapons on the premises. A comfortable temperature for clients is maintained. Lamps or lights are in all rooms. Hot water temperature measured at 110.6 degrees Fahrenheit. All toilets, washing and bathing facilities are safe, sanitary and in operating condition. Hygiene products such as soap, toilet paper, toothbrush, toothpaste, and comb were observed. All food supplies are stored, prepared, and served in a safe and healthful manner. Non-perishable foods for a minimum of one week and fresh perishable foods for a minimum of two days are available. Freezers and refrigerators are kept clean and maintain temperatures.

All bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. Sufficient toiletries accessible to clients.

Documents are posted as mandated. Last Disaster drill was conducted on 07/01/2022. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were complying and operational. The facility has fire extinguisher that is fully charged and last inspected on 01/18/2022. All toxins and knives are locked/secured and inaccessible to clients. Medications are centrally stored in a locked cabinet accessible only to staff. LPA Scott conducted a review of client records, personnel records, MAR, and medications. All medications and records are maintained in compliance with label instructions. All staff and client records are maintained in order. There were no deficiencies cited.


An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Anabelle Harrison, Administrator.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2