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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603416
Report Date: 09/02/2023
Date Signed: 09/02/2023 02:00:34 PM


Document Has Been Signed on 09/02/2023 02:00 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
GREATER LA AC/SC, 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: 152DATE:
09/02/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Kevin TaliaferroTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent required 1- year annual on 09/02/2023. LPA was met by Administrator Taliaferro and explained the purpose of the visit. LPA Ramirez conducted staff and resident file review, staff and resident interviews during the visit.

Emergency Drills: Last emergency drill was conducted on

Staff Personnel Files: Six (6) staff files were reviewed, and nine (9) staff were interviewed. LPA Ramirez did not find any discrepancies in personnel files.

Resident Files: Ten (10) resident files were reviewed, and nine (9) residents were interviewed. LPA Ramirez did not find any discrepancies in resident files.

Liability Insurance & Infection Control Plan: LPA Ramirez obtained a copy of facility Infection Control Plan and current liability insurance with an expiration date of 9/29/23.

No deficiencies are being cited today. Exit interview was conducted Administrator Taliaferro and a copy of this report and appeals rights were provided.

SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly RamirezTELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2023
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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