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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603416
Report Date: 04/28/2023
Date Signed: 04/28/2023 03:59:46 PM


Document Has Been Signed on 04/28/2023 03:59 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:MORNINGSTAR OF PASADENAFACILITY NUMBER:
198603416
ADMINISTRATOR:TALIAFERRO, KEVINFACILITY TYPE:
740
ADDRESS:951 S. FAIR OAKS AVENUETELEPHONE:
(626) 204-1700
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY:310CENSUS: 144DATE:
04/28/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Kevin Taliaferro, Executive DirectorTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Collateral visit to the facility. The purpose of today's visit is to interview resident (R1) regarding an unrelated complaint at another facility. Executive Director Kevin Taliaferro was explained the purpose of the visit.

No deficiencies were observed during the visit.

Exit interview was conducted with Business Office Manager Graciela Aquino. A copy of the report was provided.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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