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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191840767
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:09:41 PM


Document Has Been Signed on 12/01/2023 03:09 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, 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: 1DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Narkell Hobbs JamesTIME COMPLETED:
03:30 PM
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On 12/01/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual visit using the Care Inspection Tool. LPA Richard 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 one (1) resident residing in the facility.

LPA toured the physical plant, checked food service, reviewed staff files, reviewed resident files. The facility conducted last fire drill 10/30/2023. 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. The hot water temperature measured at 115.5F 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 resident. 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.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MAGIDOW FAMILY HOME
FACILITY NUMBER: 191840767
VISIT DATE: 12/01/2023
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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. LPA observed staff wearing mask. The facility has an isolation room for residents and required postings are throughout the facility. The administrator informed LPA that visitors have the option to meet with the residents inside or outside.

No deficiencies cited:

Exit interview conducted and a copy of the report was provided to the administrator Narkell Hobbs James

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
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