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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603151
Report Date: 09/29/2022
Date Signed: 09/29/2022 12:36:22 PM

Document Has Been Signed on 09/29/2022 12:36 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:HARRIS ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198603151
ADMINISTRATOR:CARPENTER, KARENFACILITY TYPE:
735
ADDRESS:14413 SOUTH HARRIS AVENUETELEPHONE:
(310) 933-8038
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 2DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karen CarpenterTIME COMPLETED:
01:00 PM
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On 09/29/22, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced Annual required visit with a primary focus on infection control measures, using the new Care Inspection Tool. LPA was met by Karen Carpenter, the director, and the purpose of today’s visit was explained. The facilities annual fees are current.

The facility is licensed to serve 4 adults ages 18 through 59. There are currently three (3) clients in placement. The facility consists of living and dining rooms, kitchen, service porch (where washer & dryer are located), 4 bedrooms, 3 bathrooms, family room, front and back yards.

LPA and Ms. Carpenter toured the physical plant. There are no bodies of water or firearms on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. There were night lights that lined the hallway to the client rooms. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.3 F. All fire extinguishers were operable and last serviced on 02/25/22. Last fire drill conducted was on 07/01/22.

LPA Scott checked client records along with staff records and found all to be compliant. In that there were current records of physician reports, admission agreements, immunization records, and mandated assessments for the clients. Moreover, staff records were current, all were associated with the facility, criminal history for each staff was processed and cleared, and all had current certifications on file.

Continued on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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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: HARRIS ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198603151
VISIT DATE: 09/29/2022
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A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguishers were charged, smoke detectors and carbon Monoxide were operable. LPA observed sensors on all doors, checked first aid kit; and found that it was compliant with a manual.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings and required postings throughout the facility. LPA also observed that the facility has a 30-day supply of Personal Protective Equipment (PPE). And all mandated posters were posted.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (cdss.ca.gov) for Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

There were no deficiencies observed during today’s visit. Exit interview held and a copy of the report was provided to the director, Karen Carpenter.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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