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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191840767
Report Date: 07/29/2021
Date Signed: 07/29/2021 12:23:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:MAGIDOW FAMILY HOMEFACILITY NUMBER:
191840767
ADMINISTRATOR:NARKELL HOBBS JAMESFACILITY TYPE:
740
ADDRESS:4010 S. ARLINGTON AVENUETELEPHONE:
(323) 293-8444
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:6CENSUS: 6DATE:
07/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Narkell Hobbs James, administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jennifer Jones conducted an unannounced annual random visit and met with Licensee Birdie King and Administrator, Narkell Hobbs James. The facility is a well landscaped one story house which is licensed for 6 ambulatory residents. There is currently six residents residing in the facility.

LPA toured the physical plant, checked food service, reviewed staff files, reviewed resident files for medical status and reviewed medications. The facility conducted last fire drill 01/2021. The home consists of 3 resident bedrooms, 1 1/2 bathrooms, laundry area, living room, dining room, and kitchen. The facility has an additional area located in the back of the house for staff use with two additional bedrooms, one bathroom, den and office. Resident bedrooms had the required furniture, 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 and a non-skid mats were in place, water temperature properly measured at 105 F in bathroom. 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 were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Outdoor shaded patio area was accessible to residents. There are no security bars or weapons on the premises.

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SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MAGIDOW FAMILY HOME
FACILITY NUMBER: 191840767
VISIT DATE: 07/29/2021
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During the visit, LPA observed the facility infection control practices. LPA observed a screening station with sanitizer in the facility and additional sanitation/PPE supplies in the staff office inaccessible to the residents. LPA observed a sign in sheet and temperature log for visitors. The administrator checked LPA's temperature upon entry. LPA observed staff wearing mask. The facility has an isolation room for residents and required postings are throughout the facility. The administrator advised LPA that visitors have the option to meet with the residents inside or outside.

No deficiencies cited:

Exit interview conducted and a copy of report was given to the administrator

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
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