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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003992
Report Date: 10/03/2022
Date Signed: 10/03/2022 03:37:39 PM


Document Has Been Signed on 10/03/2022 03:37 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:ASTORIA RETIREMENT RESIDENCESFACILITY NUMBER:
306003992
ADMINISTRATOR:TEODOR ABRUDANFACILITY TYPE:
740
ADDRESS:2209 ALTA VISTA DRIVETELEPHONE:
(949) 719-7718
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 5DATE:
10/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:George Munoz and Selena AbrudanTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver George Munoz and explained the reason for the visit. Administrator Selena Abrudan has an administrator certificate expiring on 11/30/2023.

At 1:30 PM, LPA toured the facility with Administrator Selena Abrudan. Facility has 5 residents present during today's visit, with 2 on hospice care. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms are single occupancy and had the required elements as well as restrooms stocked with soap/ sanitizer. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet and documents temperatures. First aid kit has all required items. Smoke detectors are hardwired and tested operational during today's visit. Fire extinguishers are mounted and charged. Facility mitigation plan/ infection control has been submitted and approved. LPA toured the outside grounds and observed the shaded outside visitation area. Exit gates are unlocked and self latching. LPA toured the kitchen and observed ample food supply as well as ample emergency food and water. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed select resident files during the visit and all contain updated emergency information. All residents and staff are vaccinated for Covid-19.

LPA consulted with Administrator regarding the importance of hand washing signs in all restrooms as well as ensuring the "Let Us No" poster is visible to all who enter the facility.

No deficiencies noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022
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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