<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880983
Report Date: 01/07/2022
Date Signed: 01/07/2022 03:24:43 PM

Document Has Been Signed on 01/07/2022 03:24 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BRIGHT MORNING STAR FAMILY HOME 3FACILITY NUMBER:
331880983
ADMINISTRATOR:DENILA, LELANIE F.FACILITY TYPE:
735
ADDRESS:1707 GOLDEN WAYTELEPHONE:
(909) 635-4662
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY: 6CENSUS: 2DATE:
01/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Annaliza LazoTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility to conduct an annual inspection, with emphasis on infection control. LPA Brown was greeted and granted entrance by caregiver Annaliza Lazo and LPA Brown explained the purpose of today's visit. Administrator Lelanie Denila was contacted and unable to come to the facility. Caregiver Lazo accompanied LPA Brown on a tour of the inside and outside of the facility.

During today’s visit, LPA Brown made observation pertaining to the facility’s current infection control measures. LPA Brown observed a screening area, and no proper covid signages throughout the facility. LPA Brown will be issuing a Technical Assistance Advisory Note due to no covid signs posted throughout the facility to encourage clients to report acute respiratory illness to staff, no signs posted to promote handwashing, cough/sneeze etiquette and physical distancing. In addition, LPA Brown will be issuing a Technical Assistance Advisory Note due to no signs posted at facility entrance with updates to Visitor Policy to notify of policies and procedures necessary to protect clients from infection during pandemic in accordance with Personal Rights requirements. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection are in adequate quantities, and that staff are trained in overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and clients for COVID-19, when and how to isolate/quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas/surfaces. The facility also has a plan in place to monitor clients regularly for any changes in condition and to subsequently notify the clients’s physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses.

LPA Brown requested to inspect the facility's Personal Protective Equipment (PPE) supply and LPA Brown observed the facility to not having a 30-day supply masks, and sanitizer, and no face shields/goggles, N95 masks or isolation gowns. **** continuation on LIC809C****

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2022
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRIGHT MORNING STAR FAMILY HOME 3
FACILITY NUMBER: 331880983
VISIT DATE: 01/07/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Brown will be issuing a Technical Assistance Advisory Note instead of a deficiency due it being difficult to access N95 masks, face shields and isolation gowns at numerous points during the COVID-19 pandemic. LPA Brown advised the facility to look online for items missing from their PPE supply kit, as CCL and Inland Regional Center may not have these items all the time to supply them with.

LPA Brown went over the various recommended training for facility staff with caregiver Lazo in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing of PPE. LPA Brown inquired as to if staff have been fit tested for N95 masks, and caregiver Lazo informed LPA Brown that at this time they have not been fit tested. LPA Brown will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Brown will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive clients, and N95 masks only needing to be worn when a client is COVID-19 positive or under observation while awaiting test results. Additionally, all residents and staff have been vaccinated and are practicing other COVID-19 precautions, which minimize the risk of them contracting COVID-19. Caregiver Lazo will be provided a copy of the Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks.



An exit interview was conducted with caregiver Lazo and a copy of this report (LIC 809) and LIC9102 TA Advisory Notes were provided.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7