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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603151
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:36:03 PM

Document Has Been Signed on 05/25/2023 04:36 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: 4DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Karen CarpenterTIME COMPLETED:
04:39 PM
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On 05/25/23, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced Annual required visit with a primary focus on infection control measures, using the new Care Inspection Tool. LPA was met by Regina Muhammad, the Direct Service Professional, and the purpose of today’s visit was explained.

The facility is licensed to serve 4 adults ages 18 through 59. There are currently three (4) 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 Shirley 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 115.4 F. All fire extinguishers were operable.

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.

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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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