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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603310
Report Date: 03/27/2023
Date Signed: 03/27/2023 10:19:55 AM

Document Has Been Signed on 03/27/2023 10:19 AM - 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
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: DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Edith NagelTIME COMPLETED:
10:30 AM
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On 3/27/23, Licensing Program Analyst (LPA) Felisa Shirley arrived at facility to conduct an unannounced One-Year Required Visit at the facility. LPA met with the Licensee Edith Nagel to conduct risk assessment. Facility is approved to serve 5 non-ambulatory residents and 1 bedridden resident over the age of 60.

Due to unforeseen circumstances the visit could not be completed at this time. LPA Felisa will return a a later date to complete the visit.

There were no deficiencies cited and exit interview conducted with Edith Nagel.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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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