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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603416
Report Date: 12/07/2021
Date Signed: 12/14/2021 12:07:13 PM

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: 104DATE:
12/07/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kevin Taliaferro, AdministratorTIME COMPLETED:
02:15 PM
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An informal conference was held via Microsoft Teams on 12/07/2021. The purpose of this informal meeting was to discuss the facility not complying with the Pasadena Public Health Departments' Guidance for the unvaccinated individuals at the facility.

Present in this meeting were: Araceli Ramirez (Regional Manager), Lisa Hicks (Licensing Program Manager), Cynthia Chan (Licensing Program Analyst), Whitney Frame (Pasadena Public Health Department Nurse), Lani Hashimoto-Raju (Pasadena Health Nurse), Kevin Taliaferro (Administrator), and Rhonda Guzman (Wellness Director).

Per Pasadena Public Health Department (PPHD) guidelines effective 9/17/21, the facility is required to submit a fully updated weekly report to the Pasadena Public Health Department every Monday. The facility must test all unvaccinated staff twice a week and unvaccinated residents once a week. The facility has not been compliant with the PPHD Guidance for weekly reports of unvaccinated employees.

The facility has stated they will do the following to achieve continued and substantial compliance:
* Kevin Taliferro will ensure that his staff will submit the weekly reports for unvaccinated staff and residents to PPHD every Monday.
* He has appointed backup staff to collect data and submit to PPHD on time if Staff in charge is absent.

Community Care Licensing (CCL) reminded Administrator that PPHD Guidelines must be followed as well CCL's regulations to remain in compliance otherwise citations may be warranted.

No deficiency was issued during today's meeting. An exit interview was conducted and a copy of this report was emailed to Administrator for signature.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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