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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006248
Report Date: 07/15/2024
Date Signed: 07/15/2024 02:51:12 PM


Document Has Been Signed on 07/15/2024 02:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:MORNINGSTAR SENIOR LIVING OF MISSION VIEJOFACILITY NUMBER:
306006248
ADMINISTRATOR:GONZALEZ, GEORGEFACILITY TYPE:
740
ADDRESS:28570 MARGUERITE PARKWAYTELEPHONE:
(949) 649-4855
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:198CENSUS: 77DATE:
07/15/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:George GonzalezTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a collateral visit in conjunction with complaint # 22-AS-20240710083946 filed against another facility. LPA met with Executive Director (ED) George Gonzalez and explained the reason for the visit. Resident 1 (R1) who could have knowledge regarding the complaint is residing at Morningstar Senior Living. At the time of the LPA's visit R1 was not at the facility. LPA interviewed the ED. LPA requested documents such as physician reports and service plans. During the visit LPA observed the See Something, Say Something sign (PUB 475) is posted in the main entryway of the facility. An exit interview was conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024
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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