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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
191601239
Report Date:
02/12/2025
Date Signed:
02/12/2025 02:24:43 PM
Document Has Been Signed on
02/12/2025 02:24 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
,
400 CONTINENTAL BLVD, STE 340
EL SEGUNDO
,
CA
90245
FACILITY NAME:
MIKO INN
FACILITY NUMBER:
191601239
ADMINISTRATOR/
DIRECTOR:
NAWAL SFEIR
FACILITY TYPE:
740
ADDRESS:
3017 MALCOLM AVE
TELEPHONE:
(310) 446-1714
CITY:
LOS ANGELES
STATE:
CA
ZIP CODE:
90034
CAPACITY:
6
CENSUS:
DATE:
02/12/2025
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
02:13 PM
MET WITH:
Nawaz Sfeir, Administrator
TIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 02/12/2025 LPA Yolanda Rosser was informed by Administrator Nawal Sfeir after conducting case management visit ' medication and MARS is now located in office in secured locked cabinet. LPA viewed cabinet in office to be secured and locked.
Exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISORS NAME
:
Eva M Alvarez
LICENSING EVALUATOR NAME
:
Yolanda Rosser
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/12/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/12/2025
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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