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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603416
Report Date: 06/10/2022
Date Signed: 06/10/2022 02:35:15 PM


Document Has Been Signed on 06/10/2022 02:35 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: 117DATE:
06/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kevin Taliaferro, Executive DirectorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a follow up visit for the purpose of checking the items to be corrected from the memory care unit. LPA conducted the initial inspection of the added Memory Care (Dementia) unit on 5/27/22.

During the visit today, LPA measured the hot water temperature which are within the required range of 105-120 degrees Fahrenheit. The wall tiles in apartment #206's bathroom has been repaired. The smaller outdoor patio has been temporarily closed off for residents use and Executive Director stated he will inform LPA when it reopens. The larger patio is available for residents to use at this time.

The Plan of Operation and Emergency and Disaster Plan were previously submitted for LPA's review. It is determined that the newly constructed Memory Care unit meets the Title 22 regulations and is ready to serve residents.

An exit interview was conducted. A copy of this report was provided to the Executive Director.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
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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