331880983-1-23-2025-56-AS-BALN-DD7TQB-20250123135539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880983
Report Date: 01/23/2025
Date Signed: 01/23/2025 01:55:46 PM

Document Has Been Signed on 01/23/2025 01:55 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
, CA 92507

FACILITY NAME:	BRIGHT MORNING STAR FAMILY HOME 3		FACILITY NUMBER:	331880983
ADMINISTRATOR/ DIRECTOR:	DENILA, LELANIE F.		FACILITY TYPE:	735
ADDRESS:	1707 GOLDEN WAY		TELEPHONE:	(909) 635-4662
CITY:	BEAUMONT	STATE: CA	ZIP CODE:	92223
CAPACITY: 6		CENSUS: 3	DATE:	01/23/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:40 PM
MET WITH:	Annaliza Lazo House Manager		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with House Manager Annaliza Lazo and was granted entry into the facility.

At the time of the visit there was one (1) staff present, and all clients were attending day program. The facility is an five (5) bedroom, three (3), bathroom home, with a kitchen/dining area, living room, and attached garage.

The facility is an Adult Residential Facility (ARF) level 4i vendorized by Inland Regional Center. Licensed capacity is (6) current census (3). LPA was accompanied by Annaliza to conduct a general overall inspection, which included, but was not limited to, the following.

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 72 degrees F. LPA inspected client’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately.

LPA observed sufficient furniture and lighting throughout the facility. LPA measured the water temperatures in the bathrooms that ranged from 105-116 degrees F. The facility is equipped with operating smoke detectors, carbon monoxide detectors and fully charged fire extinguisher.

Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: BRIGHT MORNING STAR FAMILY HOME 3	FACILITY NUMBER: 331880983
	VISIT DATE: 01/23/2025

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There was a designated storage space for client/staff files. Medications are kept inside medication cabinet inaccessible to clients in care. Overall, the facility is clean, in good repair, and operating in safe conditions. .

Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department.

Record Review: LPA reviewed two(2) client files for admission agreements, updated physician reports, and needs and services plans which appeared to be current. Medications were audited at random and appeared to be dispensed appropriately by staff members. P&I was accounted counted for and matched with the ledger.

LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Facility Manager Annaliza Lazo at the conclusion of the visit with appeal rights.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC809 (FAS) - (06/04)

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