198603416-5-27-2022-28-AS-CDCN-CETU8Q-20220527152155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603416
Report Date: 05/27/2022
Date Signed: 05/27/2022 03:22:14 PM

Document Has Been Signed on 05/27/2022 03:22 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 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: 117	DATE:	05/27/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kevin Taliaferro, Executive Director		TIME COMPLETED:	03:30 PM

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Licensing Program Analysts (LPAs) Cynthia Chan and Bennette Pena conducted a case management for the purpose of a memory care unit addition to the plan of operation. LPAs met with Executive Director, Kevin Taliaferro. On 5/2/2022, the fire inspector granted access control for use in the memory care unit. In addition, clients who become temporarily bedridden may continue to be housed on any story of the facility. The fire department shall be notified within 48 hours.

LPAs toured the memory care unit which is located on the 2^nd floor of this 4-story building. There are 28 resident bedrooms in this memory care unit. Each resident room has a large closet space. At this time, the residents’ rooms are not furnished. Per the Executive Director, the residents will bring in their own beds, chairs, lamps, and nightstand. All bathrooms have a working toilet and shower. The showers have grab bars and non-skid mats.

Medication for residents in this unit will be distributed by a Med Tech and will be locked in the medication cart. The residents residing in this memory care unit will have their records kept in the nurse’s office.

Laundry room is secured with washer and dryer which will be locked and inaccessible to residents. Staff will provide laundry service. Laundry supply will be secured and locked separately. Knives, chemicals products, disinfectants will be locked in a storage room.

The memory care unit consists of a dining room in which food will be delivered from the kitchen downstairs. The kitchen area consists of a secured lock door to prevent residents from entering the kitchen which contains a working stove, refrigerator, and microwave.

There are two outdoor space for leisure use and are enclosed by glass panels.

(Continue on LIC809C)

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/27/2022

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The main exit doors require a code to open the doors and can be disarmed by a fire alarm activation in case of an emergency. There is one emergency door that leads to the stairwell, which will produce an alarm sound when pushed. The door will open after 15 seconds.

Each room has a fire alarm system that is hard-wired and connected to the local fire department. The fire extinguishers were last inspected on 5/3/2022.

The hot water temperature was tested in each of the residents’ rooms and common bathroom. The following rooms were measured below 105 degrees: Room #212, #226, #236, #250, #252, and #254. These rooms are measured above 120 degrees: Room #210, #216, #228, #240, #258, #260, #262, #264, #266, #270, and the common bathroom by the outdoor patio. Room #220 does not have a working faucet.

LPAs observed the following items that need to be corrected before this memory care unit can be licensed.

1. Hot water temperature must be adjusted to read between 105 – 120 degrees Fahrenheit. See room numbers above.

2. Room #260 bathroom tiles by the sink must be repaired.

3. The side gaps next to the walls in the outdoor patio must be secured.

An exit interview was conducted and a copy of this report has been furnished to the Executive Director.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

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