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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320451
Report Date: 05/30/2024
Date Signed: 06/11/2024 02:16:19 PM


Document Has Been Signed on 06/11/2024 02:16 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
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814



FACILITY NAME:MAGICAL TOUCH CARE HOMEFACILITY NUMBER:
198320451
ADMINISTRATOR:MATIAS, MARIAFACILITY TYPE:
740
ADDRESS:22547 HARLINE CT.TELEPHONE:
(310) 328-3725
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY:6CENSUS: 3DATE:
05/30/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria MatiasTIME COMPLETED:
10:30 AM
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COMP II by CAB successfully completed

Facility Type: RCFE
Application Type: CHOW
Capacity: 6
Census: 3
Method: Telephone call with CAB
COMP II Participants: Applicant/Administrator; Maria Matias & Analyst; Tammy Edwards

Applicant/Administrator participated in COMP II at CAB via telephone call with Analyst at CAB. Identification of the Applicant/Administrator was verified by confirming driver’s license number. During COMP II, Applicant/Administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant/Administrator was advised to email/fax signed LIC 809 with copy of photo ID to CAB.

During COMP II, CAB Analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing readiness
SUPERVISOR'S NAME: Darla NeeleyTELEPHONE: (916) -65-7817
LICENSING EVALUATOR NAME: Tammy EdwardsTELEPHONE: 916-651-9141
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024
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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