198203165-5-3-2024-11-AS-RCLD-D4WRP9-20240503131135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198203165
Report Date: 05/03/2024
Date Signed: 05/03/2024 01:11:57 PM

Document Has Been Signed on 05/03/2024 01:11 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	MORNINGSIDE TERRACE		FACILITY NUMBER:	198203165
ADMINISTRATOR:	CESAR FELICIANO		FACILITY TYPE:	740
ADDRESS:	17219 ATKINSON AVENUE		TELEPHONE:	(310) 532-0257
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	6	CENSUS: 4	DATE:	05/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Administrator Bien Cadungog		TIME COMPLETED:	01:25 PM

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On 05/03/24 at 8:32 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Administrator Bien Cadungog.

The facility is licensed to serve elderly clients (60 years and above) ambulatory and non-ambulatory. Approved hospice waiver for one client only.

The facility is a single story structure located in a residential neighborhood. It consists (6) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and a detached 2 car garage. The facility is clean, sanitary, and in good repair.

The Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 110.6 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.

Common areas were clean and clear of hazards, doorways were free of obstructions.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MORNINGSIDE TERRACE	FACILITY NUMBER: 198203165
	VISIT DATE: 05/03/2024

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LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced November 28, 2023 was observed in the kitchen area. Administrator tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional.

Five (5) staff records were reviewed and two (2) staff interviews were conducted.

Four (4) resident records were reviewed and, 4 out of 4 resident records had medical assessments and pre-appraisal or reappraisals. Two (2) residents’ medication was reviewed and one (1) residents were interviewed.

No deficiencies are being cited.

An exit interview was conducted, technical assistance provided and a copy of this report was discussed and left with Administrator Bien Cadungog.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

LIC809 (FAS) - (06/04)

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