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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004470
Report Date: 11/23/2022
Date Signed: 11/23/2022 02:59:24 PM


Document Has Been Signed on 11/23/2022 02:59 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:ABERDEEN TERRACEFACILITY NUMBER:
306004470
ADMINISTRATOR:PETER SCHENKELBERGFACILITY TYPE:
740
ADDRESS:25102 VESPUCCI ROADTELEPHONE:
(949) 357-6666
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 6DATE:
11/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Peter SchenkelbergTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at Aberdeen Terrace to conduct an unannounced Required 1 Year Inspection with an emphasis on Infection Control. At 2:00pm, LPA Cho was greeted and granted entry by Activity Staff Lina Duque. Staff Duque is self-employed and comes twice per week to provide activities for the residents. Also present were Caregivers Cecelia Ortaleza and Charly Ban Hinal.

Upon arrival, LPA completed the Coronavirus 2019 (COVID-19) screening procedure upon entry. There are no active COVID-19 cases as of today. LPA observed a check-in station with a thermometer. LPA observed the required COVID-19 precautionary signs posted throughout the facility. The Complaint Poster (PUB475) met the size requirement. The facility is licensed for six non-ambulatory residents and has a hospice waiver for three. There are currently six residents living in the facility of which none are receiving hospice care.

At 2:16pm, LPA Cho conducted a tour of the physical plant with Caregiver Charly Hinal. Administrator Peter Schenkelberg arrived approximately 2:30pm and assisted with the tour. The facility is a two story home. The first floor is occupied by the residents and the second floor occupied by the live-in staff. There are a total of six resident bedrooms and seven resident bathrooms. LPA checked the resident bedrooms. The resident bedrooms had the required furnishings. The resident bathrooms were checked. Grab bars were secure, the toilets worked properly, the showers were free of mold/mildew, and slip mats were in place. Resident bath towels and personal hygiene supplies were adequately stocked including hand soaps and paper towels. LPA observed hand washing signs in the bathrooms. The hot water temperature in the resident bathrooms measured at 110.4 degrees Fahrenheit in Bathroom #1, 110.6 degrees Fahrenheit in Bathrooms #2/#3, 109.7 degrees Fahrenheit in Bathroom #4, 111.7 degrees Fahrenheit in Bathroom #5, 114.2 degrees Fahrenheit in Bathroom #6, and 111.3 degrees Fahrenheit in Bathroom #7. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. The fire extinguishers were fully charged and serviced on 07/30/2022.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ABERDEEN TERRACE
FACILITY NUMBER: 306004470
VISIT DATE: 11/23/2022
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Smoke/carbon monoxide detectors and auditory devices were tested and operational. Medications, toxins, and sharps were locked and inaccessible to the residents. LPA Cho toured the outside grounds. No body of water was present. There was shading and sufficient seating for residents. The exit gate was self-closing and self-latching. Walkways around the facility were clear of hazards, and LPA observed sufficient supply of emergency food/water and PPEs.

Based on the observations made during today's visit, no deficiency is cited in this review as per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Administrator Peter Schenkelberg, and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
LIC809 (FAS) - (06/04)
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