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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409909
Report Date: 04/08/2022
Date Signed: 04/08/2022 10:41:09 AM

Document Has Been Signed on 04/08/2022 10:41 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:BRIGHT MORNING STAR FAMILY HOMEFACILITY NUMBER:
336409909
ADMINISTRATOR:PENDINGFACILITY TYPE:
735
ADDRESS:40278 LINCOLN STTELEPHONE:
(951) 845-7995
CITY:CHERRY VALLEYSTATE: CAZIP CODE:
92223
CAPACITY: 6CENSUS: 4DATE:
04/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Leilani DenaliTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. At 9:50 AM, Administrator Denila arrived at the home and LPA Bueno identified herself to Denila. Denila verified that there are no active and/or suspected Covid-19 cases in the facility.

During the inspection, LPA Bueno and Administrator Denila toured the facility inside and out. The facility has a gated empty pool. The facility has charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. Outdoor and indoor passageways were kept free of obstruction. Cleaning supplies, medications, and sharps were kept in a safe and locked place. Medications were stored in an inaccessible med room. Sharps were stored in a secured area. LPA observed a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. The facility menu was available for review. The client bedrooms had the required furniture and sufficient lighting. The facility had a supply of additional linen and extra hygiene items for the clients.

LPA Bueno interviewed Administrator Denila regarding the facility's infection control measures and inspected the facility for regulatory compliance. LPA observed appropriate postings in the facility, including COVID-19 symptoms postings and visitation policies, which were in accordance with the Department's guidelines. LPA observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases and that staff are trained in the facility's infection control measures.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2022
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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: BRIGHT MORNING STAR FAMILY HOME
FACILITY NUMBER: 336409909
VISIT DATE: 04/08/2022
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The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms.

LPA Bueno observed that the facility appeared to be meeting operational requirements. LPA observed no apparent health and safety risks at the time of visit. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Administrator Denila.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
LIC809 (FAS) - (06/04)
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