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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600562
Report Date: 10/07/2022
Date Signed: 10/07/2022 06:08:45 PM

Document Has Been Signed on 10/07/2022 06:08 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
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:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Maria Theresa "Tek" Ordiniza/Assistant Administrator TIME COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA met with Assistant Administrator Maria Theresa "Tek" Ordiniza, and informed the purpose of visit.

Facility has an approved LIC808 COVID-19 Mitigation Plan. The facility submitted the new Infection Control Plan which LPA received on June 30, 2022. Three staff were fit tested for N95 respirators on March 4. 2022 and other 2 on March 8, 2022. Staff Lolita Chan is still to be fit tested.

LPA inspected the facility inside out with Maria Theresa "Tek" Ordiniza. LPA observed screening station by the front entrance with visitor's log, hand sanitizer, surgical masks and no touch temperature probe. Routine symptom screening of temperature and symptoms checking are done at entry for all staff and residents and recorded daily. Centrally stored PPEs checked. There were COVID-19 signages/posters all throughout the facility and hand washing signs on all bathroom/toilets. Food supplies were observed adequate for 7 days of non-perishables and 2 days of perishables. .

Fire extinguisher inspected and observed fully charge with tag showed serviced April 25, 2022. Water temperature in one of the common bathrooms was tested and measured at 105.3 degrees Fahrenheit. Smoke detector tested and observed operational.

LP observed the following:
1. Trash bin in the kitchen with no lid.
2. Supply of disposable gowns not sufficient for 30 days for 5 staff


.....continued on 809C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MORNING SUN CARE HOME
FACILITY NUMBER: 015600562
VISIT DATE: 10/07/2022
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Administrator to submit copies of the following updated documents by October 21, 2022.
1. LIC308 Designation of Facility Responsibility
2. LIC500 Personnel Report
3. LIC610D Emergency Disaster Plan (9 pages)
4. Proof of Surety bond coverage
5. Monkeypox Infection Control Plan

No citation issued on this day.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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