300613274-10-17-2022-22-AS-ETAA-CKAT9X-20221017143240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300613274
Report Date: 10/17/2022
Date Signed: 10/17/2022 02:32:45 PM

Document Has Been Signed on 10/17/2022 02:32 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	PARK VISTA AT MORNINGSIDE		FACILITY NUMBER:	300613274
ADMINISTRATOR:	HAIDY MIKHAEL ANDRAWES		FACILITY TYPE:	740
ADDRESS:	2527 BREA BLVD		TELEPHONE:	(714) 256-8008
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	85	CENSUS: 68	DATE:	10/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:32 PM
MET WITH:	Christopher Oakeson		TIME COMPLETED:	02:45 PM

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Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with Executive Director Christopher Oakeson and stated the purpose of this visit.

The facility is a two-level structure licensed for Eighty-Five non-ambulatory with a hospice waiver for ten. Ten may be bedridden. This facility offers Residential Care for the Elderly/Dementia. Facility is divided by Assisted Living and Memory Care.

At about 12:32 pm LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed residents in care and staff members on duty. LPA toured the interior and exterior portions of the facility. Resident rooms were selected at random for inspection. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Resident rooms did have private restrooms. Resident restrooms were observed to be in good repair and provided with grab bars and hot water was measured between 111.5 – 117.8 degrees Fahrenheit. LPA was informed that fire alarms and carbon monoxide alarms were being repaired during the inspection. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. Facility had adequate supplies of personal protective equipment in place. Fire extinguishers were observed to be charged and operational. Kitchen was in good repair and in a separate room cleaning supplies and sharp items were inaccessible to residents in care. Facility also had activity rooms, a beauty salon, dining rooms and libraries all of which were in good repair. Medications were kept locked in a medication room.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK VISTA AT MORNINGSIDE	FACILITY NUMBER: 300613274
	VISIT DATE: 10/17/2022

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For the exterior portion, facility had an outside patio with furniture in good repair; and grounds were free of tripping hazards. LPA Tapia reviewed the COVID 19 mitigation plan and Emergency Disaster plan of the facility. LPA made Executive Director aware of upcoming annual fees due in November.

LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed.

LPA Tapia conducted an exit interview with Executive Director Christopher Oakeson and copy of this report was explained and left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC809 (FAS) - (06/04)

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