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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601043
Report Date: 09/18/2025
Date Signed: 09/18/2025 05:19:01 PM

Document Has Been Signed on 09/18/2025 05:19 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:STAR HOUSE 1FACILITY NUMBER:
198601043
ADMINISTRATOR/
DIRECTOR:		BRODERICK, PAMELAFACILITY TYPE:
735
ADDRESS:22410 EVALYN AVENUETELEPHONE:
(310) 378-3524
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 6DATE:
09/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:16 PM
MET WITH:Clare Mills-GreyTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 09/18/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above using the full CARES Inspection Tool. LPA met with Director of Programs, Clare Mills-Grey, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) ambulatory developmentally disabled adults ages 18 through 59. Currently, the facility has (6) Harbor Regional Center client. No clients have Restricted Health Care Conditions or utilize postural support or protective devices.
Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. The property consists of the following: six (6) client bedrooms, two (2) common bathrooms, staff office, living room, kitchen, dining area, laundry room, attached garage with supplies and exercise equipment for the clients. The outside has an outdoor shaded area. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected the Client bedrooms and observed they were clean and in good repair. LPA observed client rooms have the required furniture that consists of a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforters, and pillows. LPA observed an ample supply of linens in cabinets in the laundry room. LPA observed linens and mattresses in good repair.
Bathrooms LPA observed bathrooms meet Title 22 regulations. The bathroom fixtures were observed operable and in good repair. LPA observed secured safety handrails in the bathrooms. Showers were observed clean and free of mold and/or mildew. The showers have a non-skid mat. LPA observed an ample supply of hygiene products for clients in a cabinet in the hallway. LPA observed an ample supply of towels in a closet in the hallway. The water temperature in the bathrooms measured 111.1- degrees and 111.3- degrees Fahrenheit.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
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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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)
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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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: STAR HOUSE 1
FACILITY NUMBER: 198601043
VISIT DATE: 09/18/2025
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Kitchen LPA inspected the kitchen and found it clean and sanitary. LPA observed all appliances are operable. LPA observed an ample supply of cookware, dishware, and cutlery. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. LPA observed sharps secured in a locked drawer in the kitchen and are inaccessible to clients. Cleaning supplies were observed in a locked cabinet in the garage and are inaccessible to clients. The water temperature in the kitchen measured 112.7- degrees Fahrenheit.
Common Areas LPA observed the facility was appropriately furnished during the time of visit. LPA observed two couches in the living room to accommodate all clients. LPA observed games, activities, crafts, and reading material available for client use. LPA observed a large dining table and chairs to accommodate all clients. All walkways and hallways in the facility were observed clean, clear, and free of hazards and obstructions. LPA observed all rooms and hallways have ample lighting.
Files LPA reviewed the files for six (6) clients. LPA observed six (6) out of six (6) clients files have the required documents. LPA reviewed the Clients P&I Ledger and purchase receipts and observed they are consistent with properly documented records. LPA reviewed the file for the Administrator and four (4) staff. LPA reviewed LPA observed five (5) out of five (5) staff files have the required documents, certification, clearance, and training. LPA observed the administrator’s Administrator Certificate is valid till 03/30/2027. LPA received and reviewed the facility’s Surety Bond through Liberty Mutual that is valid till 09/23/2025. LPA observed Licensing Fees are due on 12/05/2025 and the PIN number was provided.
Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the staff office. LPA observed medication in their original packaging. LPA reviewed the medication and Medication Administration Record (MAR) for six (6) clients and observed six (6) out of six (6) client’s medications is consistent with properly documented records.
Safety LPA observed smoke and carbon monoxide detectors are operable. LPA observed the last Fire Prevention Inspection was conducted by Torrance Fire Department on 08/26/2025. LPA observed three (3) fully charged fire extinguishers last serviced on 02/08/2025. The last emergency drill was conducted on 09/12/2025. LPA inspected the First Aid kit and observed it had the required items and a current manual. LPA observed all required postings posted throughout the facility. The facility has a working telephone.
Infection Control LPA observed the facility’s infection control practices. Upon entry LPA observed a sanitizing station that consists of a Visitor Sign In, hand sanitizer, masks, gloves, and a thermometer. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed Infection Control posters posted throughout the facility.
LPA did not observe or cite any deficiencies. An exit interview was conducted with Director of Programs, Clare Mills-Grey, and a copy of the report was provided
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
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