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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426544
Report Date: 02/06/2023
Date Signed: 02/06/2023 10:16:56 AM

Document Has Been Signed on 02/06/2023 10:16 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
RIVERSIDE, CA 92507
FACILITY NAME:MORENO SUNBIRD RESIDENTIAL CAREFACILITY NUMBER:
336426544
ADMINISTRATOR:KAIRU, MUMBIFACILITY TYPE:
735
ADDRESS:13215 SUNBIRD DR.TELEPHONE:
(951) 842-2756
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6CENSUS: 3DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:FACILITY MANAGER, SARAH NJOGU.TIME COMPLETED:
10:20 AM
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On February 6, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced required annual with emphasis on infection control.

LPA Mixson spoke with Administrator via telephone, introduced self and stated the purpose of the visit.

Present in the facility were one caregiver, and one resident, and the other two residents were at the day program. There are currently no positive cases of COVID-19 within the facility. All residents and staff are fully vaccinated and boosted.

LPA Mixson met with Facility Manager and toured the facility. LPA Mixson made observations pertaining to the facility's infection control measures. LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and the proper use of face coverings.

The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities.

LPA Mixson later discussed infection control practices and procedures with Facility Manager.
An exit interview was conducted and a copy of this report was given to Facility Manager.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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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