361881159-8-9-2023-56-AS-ACON-CUJSGE-20230809135150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 361881159
Report Date: 08/09/2023
Date Signed: 08/09/2023 01:52:00 PM

Document Has Been Signed on 08/09/2023 01:52 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	MORNING SIDE RESIDENTIAL CARE		FACILITY NUMBER:	361881159
ADMINISTRATOR:	HUGHES EUNIQUE		FACILITY TYPE:	735
ADDRESS:	14768 TENNESSE COURT		TELEPHONE:	(909) 600-7315
CITY:	FONTANA	STATE: CA	ZIP CODE:	92336
CAPACITY:	4	CENSUS: 1	DATE:	08/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Eunique Hughes, Administrator/Licensee		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Morning Side Residential Care Facility unannounced to conduct an Annual Inspection. LPA knocked on the door and was greeted by Eunique Hughes, Administrator. LPA introduced self and stated purpose of the visit. LPA was granted entry and provided space to work. Administrator accompanied LPA on a walk through of the facility and provided records for review. The facility has 3 resident bedrooms, 1 staff room, 2 bathrooms, kitchen, dining area, living room, attached garage, and backyard. The facility is vendorized with the Inland Regional Center and designated Level 4I. LPA conducted a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating at the capacity approved by Community Care Licensing (CCL). Pathways were observed to be free of obstruction. The facility observed in comfortable temperature. LPA inspected resident bedrooms and found that each room included required furniture such as: mattresses, night stands, adequate storage and sufficient lighting. LPA inspected resident bathrooms; 1 bathroom is for staff. 1 bathroom is for residents. Bathrooms were observed to clean and appliances functional. LPA tested the temperature from the bathroom faucet, which was observed in regulated limits. The facility is equipped with operational smoke detectors and carbon monoxide alarms. Administrator reports disaster drills are conducted on a monthly basis. Posters such as; the personal rights, letusknow, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were observed to be kept inaccessible to residents in care. There was a designated secure storage space for resident/staff files. Medications were secure and inaccessible to residents. Emergency and first aid kits were observed and readily available for residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MORNING SIDE RESIDENTIAL CARE	FACILITY NUMBER: 361881159
	VISIT DATE: 08/09/2023

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Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. The facility has a posted food menu; which is published on a monthly basis for breakfast, lunch, dinner and snacks. Facility offers its resident a variety of food items. Dishes, cups, and utensils were observed in proper storage and in adequate amounts. Emergency food and water supply were also observed.
Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members currently employed in the facility have criminal record clearance through the department.
Record Review: LPA reviewed 3 resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed 1 staff file for First Aid/CPR certification, criminal record clearance, training, and health screenings. Fire extinguisher last inspected June 2023.

Based on observations, interviews and record reviews no deficiencies will be cited per Title 22, California Code of Regulations. A copy of this report was read/reviewed with Facility Representative; signature acknowledges understanding and receipt of report and attachments.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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