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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613273
Report Date: 11/30/2021
Date Signed: 12/01/2021 10:08:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MORNINGSIDE OF FULLERTONFACILITY NUMBER:
300613273
ADMINISTRATOR:RICHARD ALLEN NORDSIEKFACILITY TYPE:
741
ADDRESS:800 MORNINGSIDE DR.TELEPHONE:
(714) 256-8000
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:712CENSUS: 407DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Richard Nordsiek, Executive DirectorTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Kathrina Chin conducted an unannounced required annual inspection in this facility. LPA met with Richard Nordsiek, Executive Director and stated the purpose of this visit.

LPA Chin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. Facility has 407 residents in care and 90 staff members on the floor. LPA toured the interior and exterior portions of the facility. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 116.7-120 F degrees Fahrenheit at four apartment units. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher were mounted and charged. For the exterior portion, facility had patio furniture in good repair, and grounds were free of tripping hazards. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies.

LPA Chin reviewed the COVID 19 mitigation plan of the facility.

For this visit, the facility was observed to be in substantial compliance with Title 22, Division 6 of the California Code of Regulations.

LPA Chin conducted an exit interview with Richard Nordsiek, Executive Director and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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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