<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600562
Report Date: 10/13/2023
Date Signed: 10/13/2023 04:03:59 PM

Document Has Been Signed on 10/13/2023 04:03 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: 5DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maria Theresa "Tek" Ordiniza/Assistant AdministratorTIME COMPLETED:
04:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 11:15 am on this day, October 13, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Maria Theresa "Tek" Ordiniza, assistant administrator, and informed the reason for visit. LPA also met with other staff, Marieta Balilo. There
were 2 residents present when LPA arrived.

Facility has Infection Control Plan that was submitted and received by LPA on June 30, 2022.

LPA inspected the facility inside and out including but not limited to bedrooms, bathroom, kitchen, dining and living areas, front, garage, front, side and backyard. Facility has supplies of food of 2 days of perishables and 7 days non-perishable. Fire extinguisher was observed fully charge with tag showed serviced March 22, 2023. Facility has carbon monoxide and smoke detectors that were tested and observed functional. Hot water temperature in the common bathroom was tested and measured at 108.4 degrees Fahrenheit. Facility conducts disaster drills monthly, and records showed last conducted October 3, 2023. Central storage for medications and storage for cleaning supplies and sharps were observed locked.

LPA reviewed 5 residents and 5 staff files, and interviewed 2 residents and 2 staff. Medications were inspected and compared with doctor's orders and records. P&I/cash resource checked and compared with ledger.


......continued on 809C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 10/13/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA received copies of updated/current of following documents:
1. LIC308 Designation of Facility Responsibility
2. LIC500 Personnel Report
3. LIC610D Emergency Disaster Plan (9 pages)
4. Proof of Surety Bond coverage

No deficiency cited.

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

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2