191601239-8-5-2024-11-AS-TWAN-D79SWK-20240717141429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191601239
Report Date: 07/17/2024
Date Signed: 08/05/2024 08:37:50 AM

Document Has Been Signed on 08/05/2024 08:37 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	MIKO INN		FACILITY NUMBER:	191601239
ADMINISTRATOR:	TANIOS EL HABAR		FACILITY TYPE:	740
ADDRESS:	3017 MALCOLM AVE		TELEPHONE:	(310) 446-1714
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	6	CENSUS: 5	DATE:	07/17/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Nawal Sfeir - Administrator		TIME COMPLETED:	02:15 PM

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

Licensing Program Analyst (LPA) Troy Watson conducted an unannounced visit to Miko Inn on 07/17/2024 at 9:56 am. The LPA met with the administrator Nawal Sfeir, and the purpose of the visit was explained. Facility is licensed to serve 6 non- ambulatory residents and currently has a census of (5) of which one may be bed ridden and the facility has an approved hospice waiver for three residents. Three residents are diagnosed with dementia and three residents are receiving hospice care services. The facility does not handle any of the resident’s money.This home is a single-story home consisting of: (6) resident bedrooms, (5) Full bathroom, (1) living room, kitchen with dining area, laundry room (located in the kitchen) and an outdoor shaded patio area. The resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew water temperature measured between 108.7 F – 113. F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors worked properly; the residence has two fire extinguishers that are fully charged. Carbon monoxide detector was operational. First Aid kits was checked and properly stocked with scissors, tape, gauze and certified manual available. No bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

No Deficiencies cited: An exit interview was conducted, and a copy of this report was provided to the Administrator Nawal Sfeir.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (424) 544-1088
LICENSING EVALUATOR NAME: Troy Watson	TELEPHONE: (424) 544-1069
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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 1