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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191840767
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:45:38 PM

Document Has Been Signed on 12/16/2024 02:45 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:MAGIDOW FAMILY HOMEFACILITY NUMBER:
191840767
ADMINISTRATOR/
DIRECTOR:
NARKELL HOBBS JAMESFACILITY TYPE:
740
ADDRESS:4010 S. ARLINGTON AVENUETELEPHONE:
(323) 293-8444
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY: 6; 6CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Birdie KingTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 12/16/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced required annual visit using the Inspection Tool. LPA met with Licensee Birdie King, and the purpose of the visit was explained. The facility is licensed for six (6) ambulatory residents ages 60 years and over. Currently there are no residents in placement. The last fire drill was conducted on 11/26/24.

The facility is a single structure located in a residential neighborhood. It consists of the following: three (3) bedrooms, one and a half (1 ½) bathrooms, living room, dining room, kitchen, and a laundry area. The facility has an additional area located in the back of the house for staff use with two additional bedrooms, one bathroom, den and office.


LPA Gonzalez and Licensee toured the physical plant. There were no bodies of water or obstructions on the premises. Resident bedrooms had the required furniture, and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and non-skid mats were in place. The bathrooms were found to be within Title 22 regulation. Water temperature properly measured between 105F-120F. A comfortable temperature was maintained in the facility. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were fully charged, and smoke and carbon monoxide detectors were operable.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: MAGIDOW FAMILY HOME
FACILITY NUMBER: 191840767
VISIT DATE: 12/16/2024
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The facility has a working telephone landline on-site. Toxins and sharps were locked and inaccessible to residents. First aid kit was checked an in order with manual. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.


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 Licensee Birdie King.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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