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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005811
Report Date: 11/09/2021
Date Signed: 11/09/2021 12:40:20 PM

Document Has Been Signed on 11/09/2021 12:40 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, 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:
(714) 530-7522
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 5DATE:
11/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Nida GranvilleTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA was screened for symptoms of Covid-19. LPA observed staff wearing masks. Administrator arrived after the LPA. LPA and the Administrator toured the facility. Smoke detectors/Carbon monoxide detectors tested operational. LPA observed a 2 day perishable supply and 7 day non-perishable food supply on hand in the kitchen. LPA observed medications locked in a kitchen cabinet. LPA observed knives kept locked in a kitchen drawer. LPA inspected the firs aid kit. The first aid kit had all the required elements. LPA observed the fireplace in the living room was screened. LPA observed all the fire extinguishers were fully charged. LPA and Administrator toured the resident bedrooms. The facility has 5 bedrooms, 1 bedroom is for the staff and four bedrooms are for the residents. 2 of the resident bedrooms are shared. LPA observed all of the resident bedrooms had the required furnishings and had enough space to accommodate the residents and their belongings. LPA and the Administrator toured the backyard. The shed in the backyard is secured and used to store extra furniture. Both exit gates are operational. The patio in the backyard has a seating area for residents that is shaded. No bodies of water observed. LPA did not observe any obstacles or hazards inside or outside of the facility. LPA consulted with the Administrator concerning reporting requirements, Guardian system and continued Covid-19 mitigation procedures. Facility has a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
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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