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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602381
Report Date: 01/10/2025
Date Signed: 01/10/2025 04:46:41 PM

Document Has Been Signed on 01/10/2025 04:46 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:MAGNIFICENT MANORFACILITY NUMBER:
198602381
ADMINISTRATOR/
DIRECTOR:		MINDA MCNAMARAFACILITY TYPE:
740
ADDRESS:22831 MADRONA AVENUETELEPHONE:
(310) 326-1617
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 4DATE:
01/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:14 PM
MET WITH:Joseph SolTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 01/10/25, the department conducted an unannounced annual visit to the facility listed above using the full CAREs tool. The department met with Licensee, Joseph Sol, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory clients, age sixty (60) and over, of which four (4) may be bedridden, with a hospice waiver of four (4). There are currently four (4) residents residing in the facility.
Physical Plant/Structure The facility is a single-story home located in a residential neighborhood. It consists of the following: five (5) resident rooms, two (2) bathrooms, living area, dining area, kitchen and outside covered patio area with a table and chairs. There is a detached garage which is used for storage. The garage contains the washer and dryer for laundry, and a freezer and refrigerator. There were no bodies of water on the premises. The department observed all walkways outside of the home to be clean, clear, and free of obstructions, hazards, and debris.
Bedrooms The department inspected all bedrooms and found them to be clean and in good repair. The department observed all bedrooms to have the required furniture, including bed(s), dresser(s), nightstand(s), chair(s), and ample storage space for resident’s personal belongings. The department observed the beds have

(1) CONTINUED ON LIC-809C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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: MAGNIFICENT MANOR
FACILITY NUMBER: 198602381
VISIT DATE: 01/10/2025
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the required linens, including a mattress cover, fitted sheets, blanket, comforter, and pillows. All bedrooms were observed with ample lighting. The department observed an ample supply of bed linens, blankets, and comforters stored in the hall cabinet, in good repair.
Bathrooms The department inspected both bathrooms and found them to be within Title 22 regulations and were clean and operational. The department observed showers have a non-skid mats, shower chair, and secured safety handrails. The department observed an ample supply of towels, hand towels, and wash cloths in the hall cabinet, in good repair. The department observed resident’s hygiene boxes and an additional supply secured in a locked cabinet in the bathroom and are inaccessible to residents. The water temperature measured 114.1-degrees and 118.8-degrees Fahrenheit.
Kitchen The department inspected the kitchen and found it to be clean and sanitary. All appliances were observed to be operational and in good repair. The department observed an ample supply of cookware, dining ware, and cutleries. The department observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. An additional supply of canned foods and a freezer were observed in the garage. The department observed all cleaning supplies secured in a locked cabinet under the kitchen sink. All knives and sharps were observed secured in a locked drawer in the kitchen. The water temperature measured 111.4-degrees Fahrenheit.

(2) CONTINUED ON LIC908-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
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: MAGNIFICENT MANOR
FACILITY NUMBER: 198602381
VISIT DATE: 01/10/2025
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Common Rooms The department observed the facility to be sanitary and appropriately furnished at the time of visit. The department observed games and activities stored in a cabinet in the living room. The living area has a couch, two (2) recliner, and two (2) chairs available for resident use. The dining room has a large table and chairs to accommodate residents. The department observed all rooms and hallways had ample lighting. The department observed all walkways and hallways inside the facility to be clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature.
Safety The department observed smoke detectors and carbon monoxide were operable. The department observed a fully charged fire extinguisher last serviced on 07/029/24. A Fire Prevention Inspection was last conducted on 07/29/24, by the Torrance Fire Department. The last emergency drill was conducted on 10/15/24. The department observed all exits clearly marked. The facility has a working landline telephone. The department reviewed and received a copy of liability insurance through Allied Health that is valid till 03/06/25. The department inspected the First Aid Kit and found it contained the required items and a current manual.
Files The department reviewed four (4) resident files and found they contained the required documents. The department reviewed the Administrator and three (3) staff files and found they contained the required documents, training, and certification. During record review, the department observed licensing fees are

(3) CONTINUED ON LIC809-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
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: MAGNIFICENT MANOR
FACILITY NUMBER: 198602381
VISIT DATE: 01/10/2025
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current. The department observed all mandated signs and documents posted throughout the facility.
Medication The department observed all Centrally Stored Medications secured in a locked cabinet in hall. All medications were observed in their original packaging. The department reviewed the medication and Medication Administration Record (MAR) for four (4) residents. The department observed resident’s MARs and medication are consistent with properly documented records.
Infection Control During the visit, the department observed the facility infection control practices. The department observed a sanitizing station and visitor log upon entry. The department observed it has hand sanitizer, masks, gloves, and a thermometer available. The department observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated infection control signs were posted throughout the facility.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the department did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview was conducted with Licensee, Joseph Sol, and a copy of this report was provided.

(4)

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
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