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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600562
Report Date: 09/30/2021
Date Signed: 09/30/2021 04:22:16 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/21/2021 and conducted by Evaluator Lizette Francisco
COMPLAINT CONTROL NUMBER: 15-AS-20210921163606
FACILITY NAME:MORNING SUN CARE HOMEFACILITY NUMBER:
015600562
ADMINISTRATOR:GALANG, ROSARIOFACILITY TYPE:
735
ADDRESS:1502 171ST STREETTELEPHONE:
(510) 481-9708
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:6CENSUS: 6DATE:
09/30/2021
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Theresa Ordinia, Back-up AdministratorTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Resident was found unresponsive at the care home.
INVESTIGATION FINDINGS:
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On 9/30/2021 at 2:35pm, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Back-up Administrator, Theresa Ordina and explained the purpose of the visit.

During the complaint investigation, LPA obtained records, interviewed staff and residents. It was alleged resident was found unresponsive at the care home. Based on record review, on 9/12/2021, C1 was admitted to the hospital due to vomiting after dinner. S2 observed C1 vomiting on the bed which prompted S2 to call 911. S2 stated, although C1 is only able to say one word at a time, C1 was alert during the incident. Based on record review of 4 clients, 4 of 4 clients are able to leave the facility unassisted. LPA interviewed C1 and was unable to obtain additional information.


REPORT CONTINUES ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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 2
Control Number 15-AS-20210921163606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MORNING SUN CARE HOME
FACILITY NUMBER: 015600562
VISIT DATE: 09/30/2021
NARRATIVE
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3 of 3 staff stated the facility's policy when clients go out to the community is to notify staff. 2 of 3 staff said there are times when clients do not let staff know . However, 3 of 3 staff said bedroom checks are conducted throughout the day. 2 of 3 clients admitted not letting staff know all the time of when they leave the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2