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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004545
Report Date: 06/10/2020
Date Signed: 06/10/2020 05:20:39 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2020 and conducted by Evaluator Joseph Alejandre
COMPLAINT CONTROL NUMBER: 22-AS-20200514113616
FACILITY NAME:ASTORIA RETIREMENT AT DOVER SHORESFACILITY NUMBER:
306004545
ADMINISTRATOR:OANA ABRUDANFACILITY TYPE:
740
ADDRESS:1412 SANTIAGO DRIVETELEPHONE:
(714) 306-2253
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 6DATE:
06/10/2020
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Oanu AbrudanTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
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9
Staff are not administering medication as prescribed by doctor.
INVESTIGATION FINDINGS:
1
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5
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13
Licensing Program Analyst (LPA) Joseph Alejandre contacted the facility via telephone to deliver findings on a complaint investigation due to COVID-19 and pre-cautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegation with the Administrator Oana Abrudan. During the investigation, LPA Alejandre interviewed staff and witnesses. The investigation into the allegation, staff are not administering medication as prescribed by doctor, revealed the following; it was alleged that facility staff refused to allow resident 1 to be given breathing treatments. On Tuesday 5/12/20 and Wednesday 5/13/20 resident 1 (R1) was having difficulty breathing. Hospice staff determined R1 needed a breathing treatment with the handheld nebulizer. The Administrator verified she witnessed hospice staff administer the breathing treatment on Tuesday 5/12/20. The Administrator reported she did not witness the breathing treatment being administered on Wednesday 5/13/20 but it was reported to her by Hospice staff that it had been administered. Hospice staff reported the breathing treatment was administered to R1 on Tuesday 5/12/20 and 5/13/20. The Administrator reported the breathing treatment was not hindered in any way. The Hospice staff verified the breathing treatment was not hindered or interfered with in any way. (Continued on LIC 9099C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20200514113616
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ASTORIA RETIREMENT AT DOVER SHORES
FACILITY NUMBER: 306004545
VISIT DATE: 06/10/2020
NARRATIVE
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Therefore, the allegation, staff are not administering medication as prescribed by doctor, is deemed UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted with the Administrator Oana Abrudan via telephone and a copy of this report was provided to Administrator Oana Abrudan via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2