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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426280
Report Date: 03/18/2022
Date Signed: 03/18/2022 01:23:36 PM

Document Has Been Signed on 03/18/2022 01:23 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MORNING STAR III RCFEFACILITY NUMBER:
336426280
ADMINISTRATOR:MACANIG, MARILYNFACILITY TYPE:
740
ADDRESS:68215 RISUENO ROADTELEPHONE:
(760) 656-7986
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 6CENSUS: 6DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Marilyn Macanig - AdministratorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with staff (S1 & S2) and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Administrator Marilyn Macanig arrived later during LPA Colvin's inspection. Below is a summary of what was observed:

Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with staff, who LPA Colvin found to be successfully incorporating the several aspects of the facility's approved Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap. LPA Colvin did not observe paper towels in the private bathrooms, though the common restroom did have both soap and paper towels. Since the private bathrooms are used only by a single resident each, they are permitted to use hand towels instead of paper towels. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns), which was located a storage closet. LPA Colvin observed the facility to not have an adequate supply of isolations gowns, as there was only one present. However, when the Administrator arrived at the facility, she was able to show LPA Colvin an additional three boxes of isolation gowns, which are kept in the garage. LPA Colvin went over the various recommended training for facility staff with S1 & S2 in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE.

LPA Colvin inquired as to if staff have been fit tested for N95 masks, and S1 stated that they were. LPA Colvin confirmed that residents are being screen daily for COVID-19 symptoms, which includes checking their temperature, as evidenced by documented logs. LPA Colvin observed a sign-in sheet at the front door of the facility, and confirmed that visitors and staff are being screened for symptoms prior to entering the facility.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MORNING STAR III RCFE
FACILITY NUMBER: 336426280
VISIT DATE: 03/18/2022
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LPA Colvin inquired about the facility's policy for checking on residents who are in isolation and positive for COVID-19. S1 stated that though they have not had any resident positive cases at the facility, if they did they would check on them and assess their symptoms daily. LPA Colvin will be issuing a Technical Advisory Note as the current recommendation is to check on positive residents at least every 4 hours. LPA Colvin is not issuing a deficiency as the facility does not and has not had any positive residents.

Additional Items:

During LPA Colvin's inspection, she inquired the names of S1 & S2, and how long they worked at the facility. LPA Colvin observed that S1 was not on the facility's staff roster, and S1 reported to LPA Colvin that they have been working at the facility for the last two years. LPA Colvin requested to see S1's staff file, and observed that while S1 has a criminal background clearance, there is no paperwork showing that S1's clearance was transferred to this facility. LPA Colvin contacted the Riverside Community Care Licensing (CCL) Regional Office and confirmed S1 clearance as well as that S1 is only associated to one of the Licensee's other facilities (Morning Star R.C.F.E., license number #336424655). Since S1 is working in the facility and the Licensee has not had S1's criminal background clearance transferred to this facility, LPA Colvin is citing a deficiency and assessing civil penalties in the amount of $500 ($100 per day worked for a maximum of 5 days).

An exit interview was conducted with Administrator Marilyn Macanig and a copy of this report, LIC809D< LIC421BG, appeal rights, and LIC9102 TA Advisory Notes were provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2022 01:23 PM - It Cannot Be Edited


Created By: Crystal Colvin On 03/18/2022 at 12:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MORNING STAR III RCFE
FACILITY NUMBER: 336426280

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(2)
Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)....

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above with at least one staff (S1), which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/19/2022
Plan of Correction
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Licensee agrees to request a transfer of S1's criminal record clearance to this facility, or to remove S1 from the staff roster. Licensee to provide LPA Colvin with proof of S1's transfer of criminal record clearance to this facility or new staff roster without S1 by Plan of Corerection date of 3/18/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Esquivel
LICENSING EVALUATOR NAME:Crystal Colvin
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022


LIC809 (FAS) - (06/04)
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