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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603151
Report Date: 07/23/2026
Date Signed: 07/23/2026 03:07:59 PM

Document Has Been Signed on 07/23/2026 03:07 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:HARRIS ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198603151
ADMINISTRATOR/
DIRECTOR:		CARPENTER, KARENFACILITY TYPE:
735
ADDRESS:14413 SOUTH HARRIS AVENUETELEPHONE:
(310) 933-8038
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 4DATE:
07/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Chukwuebuka Echianu TIME VISIT/
INSPECTION COMPLETED:
03:27 PM
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On July 23, 2026, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced visit to Harris Adult Residential Facility. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. LPA was met by DSP Chukwuebuka Echianu. Echianu contacted the administrator Karen Carpenter by telephone, and the purpose of the visit was explained. The facility is licensed to serve 4 Developmentally Disabled Clients (age 18-59). Currently, the home has (3) ambulatory clients. The clients are South Central Los Angeles Regional Center clients. None of the clients have Restricted Health Care Conditions and none utilizes postural supports or protective devices.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 3 bathrooms, dining room, kitchen, living room, outdoor shaded area, laundry room, and an attached garage.

LPA conducted records review of (4) client records, (4) staff records, (4) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

LPA toured the physical plant. There are no bodies of water on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly.

(Evaluation Report continues LIC 9099-C)

Janae Hammond
Ernand Dabuet
DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2026
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 3
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HARRIS ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198603151
VISIT DATE: 07/23/2026
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The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries were accessible to clients. The water temperature measured at 105.9 F.

LPA observed the facility to be clean and appropriately furnished at the time of visit. All window screens are clean and in good repair. 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. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The fire extinguishers (2) were charged. Smoke/ Carbon Monoxide detectors were operable. The last fire/earthquake emergency drill was conducted on May 09, 2026.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that a sanitizing station along with sign in sheets and temperature testing was located at the entrance of the facility. LPA observed that the facility had the required postings, posted throughout the facility.

The facility has a current Administrator's Certificate for Karen Carpenter (#2735) valid 12/08/25 through 12/07/27. The facility is current on CCLD annual dues.

According to the California Code of Regulations (Title 22, Division 6, Chapter 1), LPA did not observe any deficiencies, therefore no citations were issued at this time.

During today’s visit there were no deficiencies observed.

An exit interview was held, and a copy of this report was provided to Chukwuebuka Echianu, DSP.

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Ernand Dabuet
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
LIC809 (FAS) - (06/04)
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