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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880730
Report Date: 07/11/2022
Date Signed: 07/11/2022 11:36:40 AM

Document Has Been Signed on 07/11/2022 11:36 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
, CA 92507
FACILITY NAME:MORNING MIST HOMECAREFACILITY NUMBER:
331880730
ADMINISTRATOR:SANASINH, SIMMFACILITY TYPE:
740
ADDRESS:7902 NATOMA STTELEPHONE:
(949) 233-1643
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 6CENSUS: 6DATE:
07/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Brooke Sanasinh, Licensee
Simm Sanasinh, Administrator		TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Amy Goldenberg conducted this case management visit to assess the health, safety, and welfare of residents in care and is being done in response and in conduction with a complaint investigation. LPA learned that there are six (6) residents in the home.

During this visit LPA assessed the facility food supply, safety measures in place, interviewed all of the residents and toured the physical plant. There are no immediate health and safety concerns observed or reported through interview observed. Residents appear well dressed, clean, and report satisfaction with their care.

This report was reviewed with and a copy was provided to the facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2022
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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