191840767-12-6-2022-11-AS-WGIS-CLUMJS-20221206083935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191840767
Report Date: 12/01/2022
Date Signed: 12/06/2022 08:40:15 AM

Document Has Been Signed on 12/06/2022 08:40 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	MAGIDOW FAMILY HOME		FACILITY NUMBER:	191840767
ADMINISTRATOR:	NARKELL HOBBS JAMES		FACILITY TYPE:	740
ADDRESS:	4010 S. ARLINGTON AVENUE		TELEPHONE:	(323) 293-8444
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90008
CAPACITY:	6	CENSUS: 1	DATE:	12/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Narkell Hobbs James		TIME COMPLETED:	03:45 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) Wendy Gibbs conducted an unannounced annual random visit and met with Administrator, Narkell Hobbs James. There are currently 1 resident residing in the facility. Structure 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. Physical Plant 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. Bedrooms LPA inspected all resident bedrooms. The rooms had the required furniture including: bed, chair, dresser and nightstand. The beds had the necessary linens including: mattress cover, fitted sheets, blankets, pillows and comforter. Each room had ample closet space and lighting. Bathrooms Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat were in place. The water temperature measured between 105.6 degrees Fahrenheit. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Kitchen All appliances were in good working condition. LPA observed a 3-day supply of perishable foods and 10-day non-perishable food supply. All cutleries were in good condition. Knives and toxins were locked and inaccessible to residents. Water temperature measured at 106.1 degrees Fahrenheit. Common Spaces Common areas were clean and clear of hazards, doorways were free of obstructions. The living room and dining room had ample seating and lighting. Safety All smoke/carbon monoxide detectors were in good working order. Fire extinguishers were fully charged and brand new. Last emergency drill was in 04/2022. LPA inspected First Aid Kit and it had all the necessary items and the manual. There was a 90-day supply of PPEs.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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: MAGIDOW FAMILY HOME	FACILITY NUMBER: 191840767
	VISIT DATE: 12/01/2022

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Medication LPA reviewed MARs and matched them to the resident’s medications. The medications are locked in a filing cabinet in the kitchen inaccessible to resident.
Files LPA reviewed all staff files, and they contained the necessary documents. LPA reviewed resident’s file and it contained the necessary document.
Infection Control 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. LPA observed staff wearing mask. The required postings are throughout the facility.

LPA reviewed the Liability Insurance and the Surety Bond.

No deficiencies cited:

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

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC809 (FAS) - (06/04)

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