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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603416
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:20:02 PM


Document Has Been Signed on 09/19/2022 04:20 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: 160DATE:
09/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Business Office Manager, Graciela AquinoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1-year visit focusing on Infection Control Domain. LPA met with Business Office Manager, Graciela Aquino as the Executive Director/Administrator, Kevin Taliaferro, was not in the office. LPA explained the purpose of today’s visit. The facility is licensed as Residential Care for the Elderly (RCFE) for 310 non-ambulatories, serving age range 60 and over of which 25 may be bedridden. Hospice care waiver is approved for 30 residents. The current census is 131, 12 of which are in Memory Care unit, 9 Hospice residents and 110 are Assisted Living residents. At 11:21am, LPA spoke with Administrator on the phone to advise that he is on his way and will be in the facility in approximately 20-30 minutes. LPA explained the purpose of the Annual fees current. Updated Infection Control Plan which includes MonkeyPox is current and had been submitted to CCLD.

At 11:35am, LPA and Administrator walked through the facility and observed/inspected the following:
  • The facility is a low-rise 4-story building located near several retail centers. It consists of two (2) buildings, Phase1 and Phase 2 are connected.
  • The main entrance (front door) is used as the central entry point for everyone. An electronic check-in station is set up by the entrance and Covid-19 symptom screening is initiated at entry, where LPA was screened.
  • COVID-19 Infection Control screening protocols and supplies included a thermometer, PPE supplies, screening logs, and sign-in sheet were observed in the main lobby.
  • COVID-19 signage was not posted around the building, but Administrator and staff put up the signage/posters in several areas of the facility during the visit.
  • Administrator stated that the facility has 144 suites and offers independent living, assisted living and memory care units.
  • Floor plans include studio; one bedroom, one bath; one-bedroom w/den, one bath; and two-bedroom, two baths. Apartments have ample lighting, wall-to-wall carpeting, and kitchenettes.
  • Ground/First floor (1st) consists of: main lobby (central covid-19 screening area), dining room, kitchen, bistro area, library, 26 resident rooms, employee lounge/staff break room, restrooms, outdoor patio, The dining area has a separate enclosed private dining area for 20 people but it is not opened yet due to ongoing renovation. There are four (4) Administrative offices on South side of the building and another one (1) on the East side. There’s also a one (1) conference room and a discovery room used as private conference room for prospective clients or family members.


CONTINUED ON LIC809-C....
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PASADENA
FACILITY NUMBER: 198603416
VISIT DATE: 09/19/2022
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LIC 809-C / PAGE 2.....
  • The second (2nd) floor consists of 43 resident rooms of which 28 rooms are for Memory Care residents, living room (common area), dining room with a capacity for 28 residents, life enrichment room/activity area, two (2) laundry rooms – one in each side of the building (east/west), Therapy room, and Terrace.
  • The third (3rd) floor consists of 39 resident rooms, living room (common area), Massage/Salon room, Fitness Center, Foyer, Emerald Store, two (2) laundry rooms) - one in each side of the building (east/west), Game Room, Terrace and Storage room.
  • The fourth (4th) floor consists of 36 resident rooms, living room (common area), two (2) laundry rooms - one in each side of the building (east/west), Garden room/Art Studio, Sky Terrace North, Club Room, Music Room, Health Center, Foyer and Lounge.
  • Facility maintained a 30-day supply of PPE located in the supply closets in the 4th and 5th floors.
  • Staff wore face masks throughout their shift.
  • LPA toured the kitchen and checked the food supplies. There was sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. The food supply was observed to be sufficient to meet title 22 guidelines. Kitchen counters, storage areas, refrigerators and preparation areas were clean and sanitary. Dishware, utensils, cutlery, pots and pans were sufficient for food service. Knives and sharps were locked in drawer and inaccessible to the residents.
  • The laundry rooms are clean, chemicals and cleaning supplies were locked and inaccessible to residents.
  • Smoke detectors were tested and are operational. Facility is equipped with a centralized sprinkler system.
  • Fire extinguishers were last inspected on May 3, 2022. Administrator stated that the facility has 12 fire extinguishers per floor.
  • Outdoor and indoor passageways and exit doors are free of debris and obstruction.
  • Hand sanitizers are readily available around the facility.
  • Disinfectants, cleaning solutions, and extra paper towels are stored and locked in a storage room.

No deficiencies observed during the time of this visit. The facility is operating within compliance.
Exit interview conducted with Kevin Taliaferro, Administrator and a copy of this report has been provided.

***Due to time constraints, LPA was not able to complete the annual inspection for this facility. LPA will do a continuation of this inspection.***

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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