<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005811
Report Date: 05/12/2021
Date Signed: 05/12/2021 10:53:53 AM

Document Has Been Signed on 05/12/2021 10:53 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MORNING SUNRISE VILLAFACILITY NUMBER:
306005811
ADMINISTRATOR:GRANVILLE, NIDAFACILITY TYPE:
740
ADDRESS:9061 ORANGEWOOD AVE.TELEPHONE:
(213) 407-4912
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 5DATE:
05/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Administrator Nida Granville TIME COMPLETED:
11:00 AM
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 (LPA) Albert Marin made an unannounced visit to this facility to conduct a case management in relation to Complaint No. 22-AS-20201006082346 filed against another licensed facility. LPA met with AD Nida Granville and stated the purpose of the visit.

At 9:45 AM, LPA Marin conducted a tour inside the facility assisted by AD Ganville. LPA observed five residents and 2 staff members including the administrator.. LPA interviewed residents and staff members. About 10: 15 AM LPA reviewed facility records with included but not limited to admission agreements, physician's reports, needs and services plans, medication logs, staff records and training.

No citation was issued at this time.

LPA conducted an exit interview with AD Granville, A copy of this report will be provided via email and AD agreed to acknowledge its receipt.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1