198603416-1-30-2024-28-AS-RORN-D2EUTZ-20240213145247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 01/30/2024
Date Signed: 01/30/2024 02:01:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
01/12/2022 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220112132407

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: 146	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Admin Kevin Taliaferro		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Facility is not complying with Covid-19 regulations by requiring staff to return to work 3-5 days after testing positive for Covid.
Administrator is opening dining room to residents even though facility has a Covid outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)s Sanjay Vaid and Mary Flores conducted a subsequent complaint visit regarding the allegation stated above. LPA's met with Administrator Kevin Taliaferro and explained the reason for the visit.
The investigation consisted of the following: On 01/19/2022 visit LPA Margaryan toured the facility dining room, Interviewed Executive Director Kevin Taliaferro, collected copies of residents and staff roster, the licensees requirements / clearance forms regarding returning to work who have tested Covid 19, Health order from Pasadena Public Health Department (PPHD). On 01/30/2024, LPAs obtained copies of staff and resident rosters, reviewed daily COVID 19 logs from 12/01/2021 thru 01/31/2022, interviewed Administrator, Staff 1-7 (S1-S7), Resident 1- 10 (R1-R10).
(Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20220112132407

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 01/30/2024

NARRATIVE

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Investigation revealed the following: regarding allegations, Facility is not complying with Covid-19 regulations by requiring staff to return to work 3-5 days after testing positive for Covid. It is alleged that Administrator Kevin want the staff back within 3 days after testing positive for COVID 19. Interviews with ten (10) residents revealed the facility follows and will follow protocols in place regarding COVID 19. Interviews with seven(7) staff reveals that during COVID 19 onset the staff will quarantine for 5 days on the sixth day will return to work if tests results shown are negative COVID 19, if test result are positive then staff will continue to quarantine for 10 days. As per Administrator and Wellness Director all staff whom tested positive needed to present letter of clearance before returning to work. Daily logs reviewed for dates December 2021 to January 2022 all staff whom tested positive were reported to Pasadena Public Health. Per Pasadena Public Health.
Based upon record review and interviews conducted the findings indicate that, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Regarding the allegation: Administrator is opening dining room to residents even though facility has a Covid outbreak. It is alleged that Administrator Kevin wants to open the dinning room during COVID 19 outbreak. Interviews with ten (10) residents revealed six (6) residents stated that the dining rooms was closed during COVID 19 outbreaks and that meals were served in their rooms, 4(four) residents are unsure of the protocols but feel comfortable the dining room will be closed if an outbreak were to occur. Interviews with seven (7) staff reveals the during outbreak protocols were put into action. Two residents per table were allowed, social distancing rules were applied, residents whom were ill received meals in their rooms. Per Pasadena Public Health guidelines, it was recommended that tables be sanitized after each use, clean and sanitize common areas frequently.
Based upon record review and interviews conducted the findings indicate that, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview held and a copy of the report and appeal rights was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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