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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424655
Report Date: 01/27/2023
Date Signed: 01/27/2023 02:33:00 PM


Document Has Been Signed on 01/27/2023 02:33 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:MORNING STAR R.C.F.E.FACILITY NUMBER:
336424655
ADMINISTRATOR:JONAS C. ACUNAFACILITY TYPE:
740
ADDRESS:32175 CATHEDRAL CANYON DRIVETELEPHONE:
(760) 992-8901
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:12CENSUS: 8DATE:
01/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:TIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced Case Management Incident visit. LPA was greeted and granted entry by Caregiver Rita Gamez. LPA explained the purpose of the visit and met with Assistant Administrator Marilyn Ponteres. The visit is in response to the death of Resident #1 (R1), who passed away on 1/26/2023.

During LPA's visit, LPA reviewed R1's file and obtained copies of the following: ID/emergency Information, admission agreement, Physician's report, admission appraisal, medication records, and personal property records. LPA requested a copy of R1s death certificate when it is made available.

During today's visit no deficiencies were cited in regard to this incident.

An exit interview was conducted, and a copy of this report was provided to Assistant Administrator Marilyn Ponteres.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023
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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