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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603310
Report Date: 11/14/2024
Date Signed: 11/14/2024 01:54:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2024 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20241108081155
FACILITY NAME:MIRACLE MILE MANOR RCFEFACILITY NUMBER:
198603310
ADMINISTRATOR:NAGEL, EDITHFACILITY TYPE:
740
ADDRESS:6273 DEL VALLE DRIVETELEPHONE:
(323) 807-0549
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:6CENSUS: 6DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:ADMINISTRATOR EDITH NAGELTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff do not assist resident with grooming
Staff interacted inappropriately with a visitor in the presence of residents
INVESTIGATION FINDINGS:
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5
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Community Care Licensing Division (CCLD) conducted an unannounced visit to Miracle Mile Manor Facility on 11/14/2024 and was greeted by Administrator Edith Nagle (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S1-S2), residents (R1-R6), witness (W1). CCLD staff requested and reviewed copies of the following: Physician Report (dated 09/03/2021), incident report (dated 10/25/2024), admission agreement (dated 09/03/2021), Written documentation from Ms. Nagle (dated 10/25/2024)

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 11-AS-20241108081155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: MIRACLE MILE MANOR RCFE
FACILITY NUMBER: 198603310
VISIT DATE: 11/14/2024
NARRATIVE
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Regarding Allegation #1: Staff do not assist resident with grooming.

It is being alleged that staff did not cut or wash R1 hair. CCLD staff toured the facility and noted residents appeared to be clean and their hair was cut. CCLD staff looked at R1 who appeared to be clean and R1 hair was washed. CCLD staff noted R1 hair was well kept and appeared to need to be cut. CCLD staff and S1 spoke to R1. S1 offered to cut R1 hair, and R1 refused. Records indicate: R1 admission agreement (date 09/03/2021) does not indicate that the facility will provide residents haircuts. Admission agreement does indicate that the facility will provide grooming and bathing. W1 indicates that W1 was advised that R1 hair had not been cut. W1 indicates that W1 has not visited R1 and was advised by R1 that R1 hair had not been washed in some time. 2 out of 2 staff indicate that staff washes resident hair 2 times per week. 2 out of 2 staff indicate that residents private care givers cut resident hair. 2 out of 2 staff indicate that R1 did not like staff to cut R1 hair. 2 out of 2 staff indicate that R1 would have to hire a third party to cut R1 hair. 3 out of 6 residents indicate that staff does wash their hair 2 times per week and 3 out of 6 residents indicate that staff has hired third party to cut residents’ hair. 3 out of 6 residents were not verbal and not able to give a statement.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20241108081155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: MIRACLE MILE MANOR RCFE
FACILITY NUMBER: 198603310
VISIT DATE: 11/14/2024
NARRATIVE
1
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3
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5
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Regarding Allegation #2: Staff interacted inappropriately with a visitor in the presence of residents.

It is being alleged that S1 spoke to visitor inappropriately in front of residents. CCLD staff noted 2 residents in room 1 to include R1 and R2. Records indicate: Incident report (date 10/25/2024) indicates that S1 and visitor had an incident in which visitor was asked to leave the facility. Incident report (date 10/25/2024) indicates that this altercation happened in front of R1 and R2. Written record from S1 (date 10/25/2024) indicate that visitor was rude and made racial slurs to S1. S1 indicates that S1 asked visitor to leave. S1 indicates that visitor attempted to cut R1 hair and advised S1 that R1 hair needed to be washed and combed prior to a haircut. S1 indicates that S1 placed S1 hand on R1 head and visitor cut visitor finger. R1 indicates that visitor refused to cut R1 hair until R1 hair was washed. R1 indicates that S1 and visitor had incident and S1 asked visitor to leave. R2 indicates that visitor was rude to S1 and called S1 names. R2 indicates that S1 never touched visitor hand and S1 asked visitor to leave. R2 indicates that S1 acted professional with visitor.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff do not assist resident with grooming”, “staff interacted inappropriately with a visitor in the presence of residents” is found to be UNSUBSTANTIATED.



No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Edith Nagle S1.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3