198603416-3-2-2023-28-AS-RORN-CQEU6P-20230330151839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 03/02/2023
Date Signed: 03/02/2023 11:31:12 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2022 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221206115153

FACILITY NAME:	MORNINGSTAR OF PASADENA		FACILITY NUMBER:	198603416
ADMINISTRATOR:	TALIAFERRO, KEVIN		FACILITY TYPE:	740
ADDRESS:	951 S. FAIR OAKS AVENUE		TELEPHONE:	(626) 204-1700
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY:	310	CENSUS: 116	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kevin Taliaferro		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff is not properly sanitizing the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Kevin Taliaferro and explained the reason for the visit.
The purpose of the visit is to investigate the above allegation.
At today's visit interviews were conducted with Resident's R 6 and R 7 at 10:00 AM.
The initial visit was conducted on 12/08/2022 and included the following:
Interview was conducted with Administrator Kevin Taliaferro at 1:15 PM.
Interview was conducted with Staff S1 at 1:35 PM.
Tour of the facility was conducted which included dining room area and kitchen.
Interviews were conducted with Resident's R1-R5 from 1:35 PM to 2:15 PM.
In regards to the allegation Staff is not properly sanitizing the facility, based on interviews conducted and information gathered facility submitted e-mail documentation dated 11/30/2022 to Department of Public Health City of Pasadena and to Licensing informing that there are GI symptoms.
Special Incident Report (SIR) was also submitted to Licensing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20221206115153

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 03/02/2023

NARRATIVE

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Interviews with staff revealed that Department of Public Health had issued GI protocols that they have been adhering to. LPA observed documentation of GI protocols issued by department of Public Health.
Staff stated 4 or 5 residents were affected and they were put in their room for 3 days, given a BRAT diet and dining room and chairs were disinfected after each meal.
Tour of the dining room and kitchen was conducted on 12/08/2022 and LPA observed staff sanitizing the tables and in kitchen area utensils were sanitized.
LPA observed the dining room and kitchen to be clean and sanitized.
Interviews with residents who all stated staff are doing a good job and are professional and they clean and sanitize often.
Stated when there has been an accident in the dining room staff have cleaned up promptly and have taken good care of the resident.

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.

An exit interview was conducted with Administrator. A copy of this report was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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