336424658-11-20-2024-18-AS-ACAO-DB7SPF-20241120130303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336424658
Report Date: 11/20/2024
Date Signed: 11/20/2024 01:04:05 PM

Document Has Been Signed on 11/20/2024 01:04 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	MORNING STAR II R.C.F.E.		FACILITY NUMBER:	336424658
ADMINISTRATOR/ DIRECTOR:	JONAS C. ACUNA		FACILITY TYPE:	740
ADDRESS:	106 ESTRELLA STREET		TELEPHONE:	(760) 324-4679
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	11/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:50 AM
MET WITH:	Emelita Aragon, Caregiver		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE

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On 11/20/2024, Licensing Program Analysts (LPAs), Andrei Castillo and Seo Jeon arrived at the facility unannounced to conduct the required annual inspection. Upon entry, LPAs were greeted by Caregiver, Emelita Aragon and informed her of the purpose of the visit. Administrator, Marilyn Ponteres arrived a few minutes later. At the time of the visit, there were two staff members and four residents present. LPA conducted a tour of the facility with the Caregiver, reviewed facility documents and conducted interviews. The following is a summary of the visit:

Facility Overview: The facility is a one-story home with six bedrooms and five bathrooms, including an attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Facility sketch, exit routes, personal rights, “If you See Something, Say Something,” LTC Ombudsman, complaint information and emergency phone numbers were observed posted in the facility. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care.

Infection Control: There were hand hygiene and hand washing stations, and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: Floors, windows, and doors were clean and well-maintained. Furniture and fixtures were in good condition. The outdoor area which is a gated backyard was free of hazards and has a shaded area with outdoor furniture. Laundry equipment was in good working condition. LPA observed fully charged fire extinguishers. Disinfectants, cleaning solutions, and sharp and dangerous objects were securely locked and

Cont. LIC 809-C

Rikesha Stamps	TELEPHONE: (951) 212-0616
Andrei Castillo	TELEPHONE: 951-248-2222
	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

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 STAR II R.C.F.E.	FACILITY NUMBER: 336424658
	VISIT DATE: 11/20/2024

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inaccessible to residents. The smoke and carbon monoxide detectors were tested and operational, and the hot water temperature was measured at 120 °F which is within the required limits. Safety night lights were observed throughout the facility. There were no bodies of water located on the property. According to the Administrator, there are no firearms or ammunition on the premises.

Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.

Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. Administrator’s certificate has been expired since 08/18/2023. A citation was issued.

Record Review and Resident/Staff Files: LPA reviewed files for two staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four resident files were reviewed and contained all required documentation.

Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for.

Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. The required quarterly fire drill has not been conducted. A citation was issued. All facility indoor and outdoor passageways and exits were clear of obstructions and or debris. There was a first aid kit with a manual.

Citations were issued during the visit. An exit interview was conducted, and a copy of this report, LIC 809-D and appeal rights were reviewed and given to Administrator, Marilyn Ponteres.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Andrei Castillo	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/20/2024 01:04 PM - It Cannot Be Edited

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 STAR II R.C.F.E.	FACILITY NUMBER: 336424658
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Personnel Records

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/27/2024
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of administrator certification renewal by the above due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Rikesha Stamps	TELEPHONE: (951) 212-0616
Andrei Castillo	TELEPHONE: 951-248-2222
	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 11/20/2024 01:04 PM - It Cannot Be Edited

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 STAR II R.C.F.E.	FACILITY NUMBER: 336424658
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review of facility files, the licensee did not comply with the section cited above in conducting quarterly fire drills this year which poses/posed a potential health and safety or personal rights risk to persons in care.
	POC Due Date: 11/22/2024
	Plan of Correction
1 2 3 4	Licensee agrees to conduct a fire drill with staff and will submit proof of the fire drill to LPA by the plan of correction date shown above. Licensee agrees to conduct quarterly fire drills for each staff.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Rikesha Stamps	TELEPHONE: (951) 212-0616
Andrei Castillo	TELEPHONE: 951-248-2222
	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC809 (FAS) - (06/04)

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