198320326-11-2-2023-11-AS-EGOZ-CX7SWK-20231102141428

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320326
Report Date: 11/02/2023
Date Signed: 11/02/2023 02:17:13 PM

Document Has Been Signed on 11/02/2023 02:17 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:	MANNY'S CARE FACILITY		FACILITY NUMBER:	198320326
ADMINISTRATOR:	NAHUM, MANACHA		FACILITY TYPE:	740
ADDRESS:	1782 S SHERBOURNE DRIVE		TELEPHONE:	(310) 309-0405
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	6	CENSUS: 4	DATE:	11/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Noame Leibov		TIME COMPLETED:	02:45 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	On 11/2/2023, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with facility manager Noame Leibov and explained the purpose of today’s visit. LPA was granted access into the facility. The facility is an RCFE licensed for six (6) ambulatory residents, of which two (2) may be non-ambulatory. There are currently four (4) residents in this facility. The facility is a one-story structure located in a residential neighborhood. It consists of the following: (4) bedrooms, of which (2) two are unoccupied and (1) one of those unfurnished; (2) two bathrooms, a living room, dining area, kitchen, washer, and dryer. The porch is covered and has seating area with small table and two chairs. There is a large backyard with an office space located in the detached garage where staff records and client records will be kept locked. LPA observed shaded outdoor seating area for residents. LPA observed passageways, walkways, driveways, steps and patios to be free from debris and or hazards. Kitchen was inspected and observed to be clean and operational. LPA and manger Noame Leibov toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for residents personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly. One fully charged fire extinguisher was found near dining room and living room. Continued on LIC 809-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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 2

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: MANNY'S CARE FACILITY	FACILITY NUMBER: 198320326
	VISIT DATE: 11/02/2023

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
26
27
28
29
30
31
32

During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, a 30-day supply of Personal Protective Equipment (PPE) is available and sign in and out logs for visitors and staff are present in the facility. Smoke detectors and carbon monoxide detector were in compliance and operational. First aid kit is fully stocked with manual.

No deficiencies were cited at the time of this visit.

An exit interview was conducted, and a copy of this report along with appeal rights was provided to facility manager Noame Leibov.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2