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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881076
Report Date: 09/06/2024
Date Signed: 09/09/2024 07:45:40 AM

Document Has Been Signed on 09/09/2024 07:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MORNING GLORY HOMEFACILITY NUMBER:
331881076
ADMINISTRATOR/
DIRECTOR:		BUENSUCESO, ESTRELLAFACILITY TYPE:
735
ADDRESS:24533 MORNING GLORY ST.TELEPHONE:
(909) 789-8980
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 4CENSUS: 4DATE:
09/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:Administrator Estrella BuensucesoTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 9/6/24 Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced one (1) year required visit. LPA was granted entry by Licensee, Estrella Buensuceso, who was informed of the purpose of visit. At the time of the visit there were two (2) staff, Licensee/Administrator and three (3) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA observed the following during today's visit:

LPA's conducted a tour of the facility with licensee, Estrella. The physical plant contained four (4) resident bedrooms, two (2) staff bedroom, and two (2) bathrooms. The facility has a dining room, kitchen, great room, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. Kitchen and food preparation areas were free of litter and rubbish. LPA observed an additional refrigerator with perishable and non-perishable foods in the garage. Emergency food and water are stored in the garage. Water temperature measured at 109.8 meeting within the required limits. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items are located in a locked drawer. Resident bedrooms had the required bedding, furniture, and lighting. Disinfectants and cleaning solutions were secured in a locked cabinet under the kitchen sink and locked garage. The smoke and carbon monoxide detectors were tested and were observed to be operable. Centrally stored medication was observed in a locked cabinet located by the staff room.



Continuation on LIC809C...
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MORNING GLORY HOME
FACILITY NUMBER: 331881076
VISIT DATE: 09/06/2024
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Staff files reviewed have a criminal record clearance, Activities of Daily Living (ADL) training's, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, appraisals, physician reports, and needs and service plan. Facility sketch, personal rights, see something say something, and LTCO poster are posted on the walls throughout the facility. According to Licensee, Estrella, there are no firearms or ammunition on the premises.

During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee, Estrella.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
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